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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1225249139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HEALTHCARE SERVICES, INC.

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

Provider Business Practice Location Address
First Line	:	215 N MARENGO AVE
Second Line	:	SUITE 165
City	:	PASADENA
State	:	CA
Zip	:	91101-1503
Country	:	US
Telephone Number	:	626-795-1383
Fax Number	:	626-796-8366

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	05/27/2008

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