1720181217 NPI number — MAXIM HEALTHCARE SERVICES, INC.

Table of content: (NPI 1720181217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720181217 NPI number — MAXIM HEALTHCARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXIM HEALTHCARE SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720181217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7227 LEE DEFOREST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-910-1500
Provider Business Mailing Address Fax Number:
410-910-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 RUDDELL RD SE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LACEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98503-5748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-456-1680
Provider Business Practice Location Address Fax Number:
360-456-1645
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOWALCZYK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSURE COORDINATOR
Authorized Official Telephone Number:
410-910-2128

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  IS-104 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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