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	253Z00000X	In Home Supportive Care Agency		CA

General Provider Information

NPI Number	:	1912144684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	5066 N FRESNO ST
Second Line	:	SUITE 107
City	:	FRESNO
State	:	CA
Zip	:	93710-7615
Country	:	US
Telephone Number	:	559-227-2250
Fax Number	:	559-227-1481

Provider Business Practice Location Address
First Line	:	5066 N FRESNO ST
Second Line	:	SUITE 107
City	:	FRESNO
State	:	CA
Zip	:	93710-7615
Country	:	US
Telephone Number	:	559-227-2250
Fax Number	:	559-227-1481

Authorized Official
Title or Position	:	ACCOUNTS MANAGER
Name	:	MRS. MELISSA CANTU
Credential	:
Telephone Number	:	559-227-2250

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	05/15/2009

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