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
2	385H00000X	Respite Care

General Provider Information

NPI Number	:	1275778714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	7227 LEE DEFOREST DR
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	:	1820 GATEWAY DR
Second Line	:	SUITE 340
City	:	FOSTER CITY
State	:	CA
Zip	:	94404-4022
Country	:	US
Telephone Number	:	650-432-0110
Fax Number	:	650-432-0109

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

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	03/20/2009

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