MEDICARE: MAXIM HEALTHCARE SERVICES

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	251B00000X	Case Management Agency	22 495291	NY

General Provider Information

NPI Number	:	1447561758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	150 STATE ST
Second Line	:	SUITE 140
City	:	ROCHESTER
State	:	NY
Zip	:	14614-1353
Country	:	US
Telephone Number	:	585-454-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 STATE ST
Second Line	:	SUITE 140
City	:	ROCHESTER
State	:	NY
Zip	:	14614-1353
Country	:	US
Telephone Number	:	585-454-3550
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SUPERVISOR
Name	:	MS. KATHRYN R HETTINGER
Credential	:	REGISTERED NURSE
Telephone Number	:	585-454-3550

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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Directions to “MAXIM HEALTHCARE SERVICES ” Practice Location

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