Provider Demographics
NPI:1396015475
Name:MAXIM HEALTHCARE SERVISE
Entity Type:Organization
Organization Name:MAXIM HEALTHCARE SERVISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-476-0600
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:8522 NEW YORK STATE ROUTE 12E THREE MILE BAY NEW YORK 1
Mailing Address - City:THREE MILE BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13693
Mailing Address - Country:US
Mailing Address - Phone:315-649-2606
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:315-476-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181988251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health