Provider Demographics
NPI:1932344439
Name:MAXICARE, INC.
Entity Type:Organization
Organization Name:MAXICARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUE
Authorized Official - Middle Name:GINGER
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-382-4406
Mailing Address - Street 1:17512 HWY 6 S. # F9
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3749
Mailing Address - Country:US
Mailing Address - Phone:713-382-4406
Mailing Address - Fax:281-656-4504
Practice Address - Street 1:17512 HWY 6 S. # F9
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3749
Practice Address - Country:US
Practice Address - Phone:713-382-4406
Practice Address - Fax:281-656-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012331253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012331Medicaid