Provider Demographics
NPI:1043465222
Name:MAXIM HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:MAXIM HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-814-1455
Mailing Address - Street 1:4444 CORONA DR STE 137
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4323
Mailing Address - Country:US
Mailing Address - Phone:361-814-1455
Mailing Address - Fax:361-814-4066
Practice Address - Street 1:4444 CORONA DR STE 137
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4323
Practice Address - Country:US
Practice Address - Phone:361-814-1455
Practice Address - Fax:361-814-4066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXIM HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679391376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX521590951OtherTAX ID
TX521590951OtherTAX ID