NPIMap

Organization Active NPI

Maxim Healthcare Services, Inc.

  • Home Health Agency
  • Glen Allen, VA
National Provider Identifier
1104920487
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
EXEMPT Issued in VA
Legal business name
MAXIM HEALTHCARE SERVICES, INC.
Practice address
100 Concourse Blvd Ste 101
Glen Allen, VA 23059-5642
Phone
(804) 355-9800
NPI assigned
Sep 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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
Continence Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC2100X EXEMPT VA
Home Health Agency 251E00000X EXEMPT VA Primary
Personal Care AttendantGroup: 193200000X MULTI-SPECIALTY GROUP 3747P1801X EXEMPT VA
Respite Care 385H00000X EXEMPT VA

Addresses

Primary practice location

100 Concourse Blvd Ste 101
Glen Allen, VA 23059-5642

Mailing address

7227 Lee Deforest Dr
Columbia, MD 21046-3236

Other identifiers 3

IdentifierTypeStateIssuer
8751064MedicaidVA
8771502MedicaidVA
8701148MedicaidVA

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
49D0915505Maxim Healthcare Services, Inc100 Concourse Blvd, Suite 101, Glen Allen, VA 23059Certificate of waiverJun 27, 2028

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 10

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

Locations

1500 Forest Ave
Rm 115
Richmond, VA 23229

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1104920487",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CONCOURSE BLVD STE 101",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595642",
            "telephone_number": "804-355-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "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": "163WC2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Continence Care",
            "state": "VA",
            "license": "EXEMPT",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "VA",
            "license": "EXEMPT",
            "primary": true
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": "VA",
            "license": "EXEMPT",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "VA",
            "license": "EXEMPT",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8751064",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8771502",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8701148",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.