Provider Demographics
NPI:1720388606
Name:MAXIM HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:MAXIM HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:WALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-292-4354
Mailing Address - Street 1:4301 S PINE ST STE 505
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST STE 505
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7208
Practice Address - Country:US
Practice Address - Phone:253-292-4354
Practice Address - Fax:253-292-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000375251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health