Provider Demographics
NPI:1043694094
Name:MAXUS HEALTHCARE PARTNERS LLC
Entity Type:Organization
Organization Name:MAXUS HEALTHCARE PARTNERS LLC
Other - Org Name:RENEW SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-340-8176
Mailing Address - Street 1:1021 WASHINGTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3021
Mailing Address - Country:US
Mailing Address - Phone:817-769-8296
Mailing Address - Fax:817-796-1285
Practice Address - Street 1:1021 WASHINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3021
Practice Address - Country:US
Practice Address - Phone:817-769-8296
Practice Address - Fax:817-796-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care