MEDICARE: MAXIM HABILITATION SERVICES, LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1114113198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HABILITATION SERVICES, LLC

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

Provider Business Practice Location Address
First Line	:	3332 BRIDGES ST
Second Line	:	SUITE 1-A
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3280
Country	:	US
Telephone Number	:	252-726-8746
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. JEREMY SMITH
Credential	:
Telephone Number	:	410-910-1500

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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