Provider Demographics
NPI:1679721237
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:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIPES
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:21046-3236
Mailing Address - Country:US
Mailing Address - Phone:410-910-1500
Mailing Address - Fax:410-910-1600
Practice Address - Street 1:2313 WHITNEY AVE
Practice Address - Street 2:SUITE 1-B
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3504
Practice Address - Country:US
Practice Address - Phone:203-373-1696
Practice Address - Fax:203-373-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004220943Medicaid
CT00422064OtherPERFORMING PROVIDER
CT077231Medicare Oscar/Certification