NPIMap

Organization Active NPI

Maxim Healthcare Services, Inc.

  • Home Health Agency
  • Clarksville, TN
National Provider Identifier
1053543223
Registry record updated Oct 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
0000000615 Issued in TN
Legal business name
MAXIM HEALTHCARE SERVICES, INC.
Practice address
130 Alfredo Dr BLDG 2
Clarksville, TN 37042-2750
Phone
(931) 645-4293
NPI assigned
Aug 20, 2009
Last updated
Oct 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Kowalczyk
Title
Controller
Phone
(410) 910-1500

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 0000000615 TN Primary
Nursing Care Agency 251J00000X NU
Respite Care 385H00000X NU
In Home Supportive Care Agency 253Z00000X NU

Addresses

Primary practice location

130 Alfredo Dr BLDG 2
Clarksville, TN 37042-2750

Mailing address

7227 Lee Deforest Dr
Columbia, MD 21046-3236
Phone (410) 910-1500

Other practice location 1

93 Beaumont St
Clarksville, TN 37040-3217
Phone (931) 645-4293

Other practice location 2

425 N Spring St
Suite T-1
Clarksville, TN 37040-3137
Phone (931) 645-4293

Other identifiers 1

IdentifierTypeStateIssuer
1515485MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110407000076 TN Part A Provider - Home Health Agency 1658288410 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksville, TN; Brentwood, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053543223. Details of each certification follow.

Home health agency certification: CCN 447580

Legal name
MAXIM HEALTHCARE SERVICES INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 15, 2011
Last certification
Mar 4, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Sep 1, 1988 in MD
Enrollment address
115 East Park Drive
Suite 200
Brentwood, TN 37027

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Maxim Healthcare Services, IncCCN 447580 · All quality measures
Ownership
Proprietary
Certified
Jun 15, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2002917Maxim Healthcare Services Inc93 Beaumont Street, Clarksville, TN 37040Certificate of waiverJan 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Maxim Healthcare Services Inc337 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

130 Alfredo Dr
Bldg 2
Clarksville, TN 37042
Phone (931) 645-4293

425 N Spring St
Ste T1
Clarksville, TN 37040
Phone (931) 645-4293

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joseph W Marshall Individual Corporate DirectorBoard Member Jul 1, 2017
Randall D Sones Individual Corporate DirectorBoard Member Oct 1, 2009
Duane D Brickhouse Individual W-2 Managing EmployeeRegional VP of Finance Feb 11, 2011
Jarrod L Depriest Individual Corporate OfficerPresident Jan 1, 2022
Matthew Sticklin Individual Corporate OfficerCfo Aug 29, 2022
Toni-Jean L Friedman Individual Corporate OfficerVP/Gen Counsel/Sec Nov 1, 2009
Oak Investment Trust Organization, Tampa, FL 5% Or Greater Indirect Ownership Interest Mar 18, 2019 38.89%
Stephen J Bisciotti Individual 5% Or Greater Indirect Ownership Interest Mar 18, 2019 19.94%
Oak Investment Trust II Organization, Tampa, FL 5% Or Greater Indirect Ownership Interest Mar 18, 2019 39.35%
James C Davis Individual Corporate DirectorBoard Member Sep 2, 1988
Maxim Healthcare Services Holdings, Inc. Organization, Columbia, MD Corporation, Holding company, For-profit 5% Or Greater Direct Ownership Interest Mar 18, 2019 100%
William J Butz Individual Corporate DirectorBoard Member Oct 15, 2012
David Cunningham Individual W-2 Managing EmployeeAdministrator Aug 29, 2022

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790899200000",
    "number": "1053543223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 LEE DEFOREST DR",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210463236",
            "telephone_number": "410-910-1500",
            "fax_number": "410-910-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 ALFREDO DR BLDG 2",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370422750",
            "telephone_number": "931-645-4293"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "93 Beaumont St",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370403217",
            "country_code": "US",
            "telephone_number": "931-645-4293",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "425 N Spring St",
            "address_2": "Suite T-1",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370403137",
            "country_code": "US",
            "telephone_number": "931-645-4293",
            "fax_number": "866-915-6482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-20",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "410-910-1500"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TN",
            "license": "0000000615",
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1515485",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.