NPIMap

Organization Active NPI

Maxim Healthcare Services, Inc.

  • Home Health Agency
  • Modesto, CA
National Provider Identifier
1174620538
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
100000780 Issued in CA
Legal business name
MAXIM HEALTHCARE SERVICES, INC.
Practice address
4712 Stoddard Rd Ste 280
Modesto, CA 95356-9404
Phone
(209) 222-5490
Fax
(855) 456-7266
NPI assigned
Sep 20, 2006
Last updated
Jul 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 100000780 CA Primary

Addresses

Primary practice location

4712 Stoddard Rd Ste 280
Modesto, CA 95356-9404

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
HHA70313FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140930000660 CA Part A Provider - Home Health Agency 1658288410 Practice locations: Modesto, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174620538. Details of each certification follow.

Home health agency certification: CCN 553168

Legal name
MAXIM HEALTHCARE SERVICES INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 22, 2015
Last certification
Dec 11, 2018
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Sep 2, 1988 in MD
Enrollment address
1620 N Carpenter Rd
Ste C19
Modesto, CA 95351-1156
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Maxim Healthcare Services, IncCCN 553168 · All quality measures
Ownership
Proprietary
Certified
Dec 22, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide

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 24

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

View all 24

Locations

4712 Stoddard Rd
Ste 280
Modesto, CA 95356
Phone (209) 222-5490

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Eugene P Urbanowicz Individual Corporate Director Aug 25, 2009
General Electric Capital Corporation Organization, Bethesda, MD Corporation 5% Or Greater Security Interest Dec 30, 2009 6%
Betty Smee Individual W-2 Managing EmployeeDirector of Clinical Services Jun 1, 2015
Randall D Sones Individual Corporate Director Aug 25, 2009
David S. Kowalczyk Individual W-2 Managing EmployeeRegional VP of Finance Apr 7, 2014
Raymond a Carbone Individual Corporate OfficerVice President/Cfo Jan 1, 2014
Frederick M Hudson Individual Corporate Director Oct 1, 2009
Toni-Jean L Friedman Individual Corporate OfficerVP, General Counsel, Secretary Nov 1, 2009
Oak Investment Trust Organization, Tampa, FL 5% Or Greater Direct Ownership Interest Nov 13, 2006 39.89%
Stephen J Bisciotti Individual 5% Or Greater Direct Ownership InterestOwner Sep 2, 1988 19.94%
Christopher H Martinez Individual W-2 Managing EmployeeAdministrator Jan 11, 2016
Oak Investment Trust II Organization, Tampa, FL 5% Or Greater Direct Ownership Interest Jan 1, 2007 39.35%
James C Davis Individual Corporate Director Sep 2, 1988
William J Butz Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2014 0.81%
Corporate OfficerPresident, Ceo Oct 15, 2012 0.82%
Corporate DirectorBoard Member Apr 21, 2016 0.82%

All facility ownership & control disclosures 27

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Maxim Healthcare Services IncPueblo, CO, CCN 067413 Home health agency Other (100%) Feb 10, 2012
Maxim Healthcare Services IncPoland, OH, CCN 368042 Home health agency Other (100%) Jan 9, 2006
Maxim Healthcare Services IncPittsburgh, PA, CCN 397783 Home health agency Other (100%) Jan 9, 2006
Maxim Healthcare Services IncTucson, AZ, CCN 037228 Home health agency Other (100%) Feb 10, 2012
Maxim Healthcare Services IncSandy, UT, CCN 467212 Home health agency Other Jan 9, 2006
Maxim Healthcare Services IncBedford, NH, CCN 307085 Home health agency Other (100%) Feb 10, 2012
Maxim Healthcare Services IncHarrisburg, PA, CCN 397789 Home health agency Other Jan 9, 2006
Maxim Healthcare Services, Inc.Miamisburg, OH, CCN 368006 Home health agency Other Jan 9, 1996
Maxim Healthcare Services IncPlains, PA, CCN 398016 Home health agency Other (100%) Feb 10, 2012
Maxim Healthcare Services IncPhoenix, AZ, CCN 037242 Home health agency Other (100%) Apr 25, 2006
Maxim Healthcare Services IncMadison, WI, CCN 527290 Home health agency Other Jan 9, 2006
Maxim Healthcare Services IncCanton, OH, CCN 368007 Home health agency Other (100%) Jan 9, 2006
Maxim Healthcare Services IncToledo, OH, CCN 367799 Home health agency Other Jan 9, 2006
Maxim Healthcare Services IncReno, NV, CCN 297049 Home health agency Other (100%) Jan 9, 2006
Maxim Healthcare Services IncOxnard, CA, CCN 058352 Home health agency Other Jan 30, 2006
Maxim Healthcare Services IncAnchorage, AK, CCN 027032 Home health agency Other Jan 9, 2006
Maxim Healthcare Services IncFresno, CA, CCN 058323 Home health agency Other Jan 9, 2006
Maxim Healthcare Services IncLas Vegas, NV, CCN 297085 Home health agency Other (100%) Sep 2, 1988
Maxim Healthcare Services IncAllentown, PA, CCN 398065 Home health agency Other (100%) Jun 1, 2007
Maxim Healthcare Services IncColorado Springs, CO, CCN 067325 Home health agency Other (100%) Feb 10, 2012
Maxim Healthcare Services IncLa Junta, CO, CCN 067466 Home health agency Other (100%) Feb 10, 2012
Maxim Healthcare Services IncSan Luis Obispo, CA, CCN 059129 Home health agency Other (100%) Dec 4, 2009
Maxim Healthcare Services IncRoseville, CA, CCN 059117 Home health agency Operational/Managerial Control (100%) Jan 1, 2009
Maxim Healthcare Services IncYork, PA, CCN 398132 Home health agency Other (100%) Apr 28, 2010
Maxim Healthcare Services IncEvansville, IN, CCN 157680 Home health agency Other (100%) Jun 30, 2011
Maxim Healthcare Services IncCrown Point, IN, CCN 157679 Home health agency Other (100%) Jun 30, 2011
Maxim Healthcare Services IncLos Angeles, CA, CCN 053198 Home health agency Other (100%) Jun 30, 2011

Facilities with the same owner 69

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1174620538",
    "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": "4712 STODDARD RD STE 280",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569404",
            "telephone_number": "209-222-5490",
            "fax_number": "855-456-7266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "410-910-1500"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "100000780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA70313F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.