MEDICARE: MAXIHEALTH HOMECARE SPECIALISTS 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1578956819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIHEALTH HOMECARE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	1321 CITIZENS BLVD
Second Line	:	STE B
City	:	LEESBURG
State	:	FL
Zip	:	34748-3957
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 CITIZENS BLVD
Second Line	:	STE B
City	:	LEESBURG
State	:	FL
Zip	:	34748-3957
Country	:	US
Telephone Number	:	352-360-8635
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLENN H DERIT
Credential	:
Telephone Number	:	352-360-8635

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	03/11/2015

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