Provider Demographics
NPI:1770950651
Name:MAXIM HEALTHCARE
Entity type:Organization
Organization Name:MAXIM HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANP
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:303-750-1499
Mailing Address - Street 1:1552 S TRENTON CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2636
Mailing Address - Country:US
Mailing Address - Phone:303-750-1499
Mailing Address - Fax:
Practice Address - Street 1:2460 W 26TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5308
Practice Address - Country:US
Practice Address - Phone:303-487-7143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0045855251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care