Provider Demographics
NPI:1811465578
Name:MAXCEN HOUSING SOCIETY INC.
Entity type:Organization
Organization Name:MAXCEN HOUSING SOCIETY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-MAXCENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-959-4159
Mailing Address - Street 1:115C LAKE DAVENPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-9405
Mailing Address - Country:US
Mailing Address - Phone:888-959-4159
Mailing Address - Fax:888-959-4173
Practice Address - Street 1:115C LAKE DAVENPORT BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-9405
Practice Address - Country:US
Practice Address - Phone:888-959-4159
Practice Address - Fax:888-959-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL734059Medicaid