Provider Demographics
NPI:1952996597
Name:MASION MAXWELL
Entity Type:Organization
Organization Name:MASION MAXWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-629-4446
Mailing Address - Street 1:2124 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5836
Mailing Address - Country:US
Mailing Address - Phone:985-629-4446
Mailing Address - Fax:985-629-4497
Practice Address - Street 1:2124 MONROE ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5836
Practice Address - Country:US
Practice Address - Phone:985-629-4446
Practice Address - Fax:985-629-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care