Provider Demographics
NPI:1407191612
Name:MAXUS HEALTHCARE PARTNERS LLC
Entity Type:Organization
Organization Name:MAXUS HEALTHCARE PARTNERS LLC
Other - Org Name:RENEW HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF QM/COMPLIANCE
Authorized Official - Prefix:MISS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-921-6400
Mailing Address - Street 1:1021 WASHINGTON AVE
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:817-921-6400
Mailing Address - Fax:817-921-6407
Practice Address - Street 1:1021 WASHINGTON AVE
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:817-921-6400
Practice Address - Fax:817-921-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15695251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457893Medicare Oscar/Certification