Provider Demographics
NPI:1922119460
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:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMICA
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 1:1324 BELMONT AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4584
Practice Address - Country:US
Practice Address - Phone:410-677-4900
Practice Address - Fax:855-857-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2393251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0166-DL5811Medicaid
MD5550432-03Medicaid
MD4136888800Medicaid
MD095102100Medicaid