Provider Demographics
NPI:1801825690
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 CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOWALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-910-1730
Mailing Address - Street 1:7227 LEE DEFOREST DRIVE
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 1:3665 JFK PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3152
Practice Address - Country:US
Practice Address - Phone:970-493-9300
Practice Address - Fax:855-218-7223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXIM HEALTHCARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04I157251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28425774Medicaid
CO28425774Medicaid