Provider Demographics
NPI:1063453926
Name:MAXIMACARE LLC
Entity Type:Organization
Organization Name:MAXIMACARE LLC
Other - Org Name:ARDENT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEILS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-293-1515
Mailing Address - Street 1:700 PARKER SQ STE 265
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7449
Mailing Address - Country:US
Mailing Address - Phone:972-471-1111
Mailing Address - Fax:972-692-6936
Practice Address - Street 1:700 PARKER SQ STE 265
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7449
Practice Address - Country:US
Practice Address - Phone:972-471-1111
Practice Address - Fax:972-692-6936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXIMACARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009193251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457809Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER