NPIMap

Organization Active NPI

Maxim Healthcare Services, Inc.

  • Home Health Agency
  • San Bernardino, CA
National Provider Identifier
1063520286
Registry record updated Aug 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
240000503 Issued in CA
Legal business name
MAXIM HEALTHCARE SERVICES, INC.
Practice address
560 E Hospitality LN Ste 400
San Bernardino, CA 92408
Phone
(909) 891-1599
NPI assigned
Aug 28, 2006
Last updated
Aug 8, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2018

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

Authorized official

Name
David Kowalczyk
Title
Regional VP of Finance
Phone
(410) 910-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 240000503 CA Primary

Addresses

Primary practice location

560 E Hospitality LN Ste 400
San Bernardino, CA 92408

Mailing address

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

Other practice location 1

1845 Business Center Dr
Suite 105
San Bernardino, CA 92408-3467
Phone (909) 891-1599

Other identifiers 1

IdentifierTypeStateIssuer
HHA57299HMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Maxim Healthcare Servise337 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

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

View all 18

Locations

1845 Business Center Dr
Ste 105
San Bernardino, CA 92408
Phone (909) 891-1599

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533686400000",
    "number": "1063520286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 LEE DEFOREST DRIVE",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "21046",
            "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": "560 E HOSPITALITY LN STE 400",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92408",
            "telephone_number": "909-891-1599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1845 Business Center Dr",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924083467",
            "country_code": "US",
            "telephone_number": "909-891-1599",
            "fax_number": "909-891-1588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2018-08-08",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "REGIONAL VP OF FINANCE",
        "authorized_official_telephone_number": "410-910-1500"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "240000503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA57299H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.