Provider Demographics
NPI:1336465533
Name:MAXIM HEALTHCARE
Entity Type:Organization
Organization Name:MAXIM HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONEL CORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-476-6000
Mailing Address - Street 1:224 HARRISTON STREET SUITE 680
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-476-6000
Mailing Address - Fax:
Practice Address - Street 1:224 HARRISON ST
Practice Address - Street 2:SUITE 680
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3056
Practice Address - Country:US
Practice Address - Phone:315-476-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2962481251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care