Provider Demographics
NPI:1275896037
Name:MAXIM
Entity Type:Organization
Organization Name:MAXIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH AIDE
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LAMARR
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:SR
Authorized Official - Credentials:BA
Authorized Official - Phone:720-324-3755
Mailing Address - Street 1:17908 E AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2122
Mailing Address - Country:US
Mailing Address - Phone:720-324-3755
Mailing Address - Fax:
Practice Address - Street 1:17908 E AMHERST AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-2122
Practice Address - Country:US
Practice Address - Phone:720-324-3755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness