MEDICARE: MAXICARE, 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	012331	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932344439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXICARE, INC.

Provider Business Mailing Address
First Line	:	17512 HWY 6 S. # F9
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-3749
Country	:	US
Telephone Number	:	713-382-4406
Fax Number	:	281-656-4504

Provider Business Practice Location Address
First Line	:	17512 HWY 6 S. # F9
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-3749
Country	:	US
Telephone Number	:	713-382-4406
Fax Number	:	281-656-4504

Authorized Official
Title or Position	:	PRESIDENT-OWNER
Name	:	HUE GINGER PHAM
Credential	:
Telephone Number	:	713-382-4406

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	11/08/2021

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Directions to “MAXICARE, INC. ” Practice Location

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