Provider Demographics
NPI:1710199690
Name:MAXIMA GROUP BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:MAXIMA GROUP BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-795-1704
Mailing Address - Street 1:1001 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-2101
Mailing Address - Country:US
Mailing Address - Phone:985-795-1704
Mailing Address - Fax:985-795-1706
Practice Address - Street 1:1001 15TH STREET
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-2101
Practice Address - Country:US
Practice Address - Phone:985-795-1704
Practice Address - Fax:985-795-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA10713315P00000X
LASIL10710315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1463043Medicaid
LA1477443Medicaid
LA1191612Medicaid