=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518290220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXIN HEALTH CARE SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2009
-----------------------------------------------------
Last Update Date | 09/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3756 SANTA ROSALIA DR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-941-2276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13508 ARCTURUS AVE
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90249-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-941-2276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. MARCEL CHIDI NJOKU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-941-2276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0800X
-----------------------------------------------------
Taxonomy Name | Recovery Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------