=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659268571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXIM HEALTHCARE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9239 W CENTER RD STE 100
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68124-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-399-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1170 26 RD
-----------------------------------------------------
City | DAVID CITY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68632-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-383-5094
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPN
-----------------------------------------------------
Name | MARISSA KATHELENE WESTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 308-383-5094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------