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Organization Active NPI

Maxim Healthcare Services, Inc.

  • Home Health Agency
  • Los Angeles, CA
National Provider Identifier
1316970064
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
980001345 Issued in CA
Legal business name
MAXIM HEALTHCARE SERVICES, INC.
Practice address
3255 Wilshire Blvd Ste 700
Los Angeles, CA 90010-1411
Phone
(323) 296-3477
NPI assigned
Jul 8, 2006
Last updated
Apr 4, 2023By the provider in NPPES
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
Mr. David S. Kowalczyk
Title
Controller
Phone
(410) 910-2128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 980001345 CA Primary

Addresses

Primary practice location

3255 Wilshire Blvd Ste 700
Los Angeles, CA 90010-1411

Mailing address

7227 Lee Deforest Drive
Columbia, MD 21046-3405
Phone (410) 910-1500

Other identifiers 1

IdentifierTypeStateIssuer
HHA70299FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141124000756 CA Part A Provider - Home Health Agency 1658288410 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316970064. Details of each certification follow.

Home health agency certification: CCN 053198

Legal name
MAXIM HEALTHCARE SERVICES INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 19, 2018
Last certification
Dec 2, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Sep 1, 1988 in MD
Enrollment address
3255 Wilshire Blvd
Ste 700
Los Angeles, CA 90010-1411
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Maxim Healthcare Services, IncCCN 053198 · All quality measures
Ownership
Proprietary
Certified
Feb 19, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide

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 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

3255 Wilshire Blvd
Ste 700
Los Angeles, CA 90010
Phone (213) 296-3477

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
Maxim Healthcare Services Inc Organization, Columbia, MD For-profit Other Jun 30, 2011 100%
Joseph W Marshall Individual Corporate DirectorBoard Member Apr 20, 2016
Randall D Sones Individual Corporate Director Aug 25, 2009
Jarrod L Depriest Individual Corporate OfficerPresident Jan 1, 2022
Matthew Sticklin Individual Corporate OfficerCfo Aug 29, 2022
David S. Kowalczyk Individual W-2 Managing EmployeeRegional VP of Finance Apr 24, 2014
Toni-Jean L Friedman Individual Corporate OfficerSr VP/Gen Counsel/Secretary Oct 25, 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 Director 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 Apr 21, 2016

All facility ownership & control disclosures 26

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

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1316970064",
    "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": "210463405",
            "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": "3255 WILSHIRE BLVD STE 700",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101411",
            "telephone_number": "323-296-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "410-910-2128",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980001345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA70299F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.