Provider Demographics
NPI:1013795574
Name:MAXTON AGENCY LLC
Entity Type:Organization
Organization Name:MAXTON AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:O
Authorized Official - Last Name:IDOWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-735-1096
Mailing Address - Street 1:1120 112TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4547
Mailing Address - Country:US
Mailing Address - Phone:612-735-1096
Mailing Address - Fax:
Practice Address - Street 1:1120 112TH LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4547
Practice Address - Country:US
Practice Address - Phone:612-735-1096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency