MEDICARE: MAXIM HEALTHCARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	317414	MN

General Provider Information

NPI Number	:	1053414193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	7227 LEE DEFOREST RD
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3236
Country	:	US
Telephone Number	:	410-910-1500
Fax Number	:	410-910-1600

Provider Business Practice Location Address
First Line	:	5353 WAYZATA BLVD
Second Line	:	SUITE 402
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1340
Country	:	US
Telephone Number	:	952-545-1140
Fax Number	:	952-546-2071

Authorized Official
Title or Position	:	REGIONAL CONTROLLER
Name	:	STEPHEN WALSH
Credential	:
Telephone Number	:	410-910-1500

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/22/2020

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