Provider Demographics
NPI:1538123740
Name:MAXIM HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:MAXIM HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-910-1500
Mailing Address - Street 1:7227 LEE DEFOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3405
Mailing Address - Country:US
Mailing Address - Phone:410-910-1500
Mailing Address - Fax:410-910-1600
Practice Address - Street 1:901 W ROSEDALE ST STE 150
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4672
Practice Address - Country:US
Practice Address - Phone:817-877-0904
Practice Address - Fax:817-877-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7096251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012717Medicaid
TX147896801Medicaid
TX001012717Medicaid