Maxim Healthcare Services, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

003757-1 Issued in IN

Legal business name

MAXIM HEALTHCARE SERVICES, INC.

Practice address

3000 East Coliseum Blvd.
Suite 300
Ft. Wayne, IN 46805

Phone

(260) 432-1166

Fax

(260) 436-3914

NPI assigned

Aug 27, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Duane D Brickhouse

Title

VP of Finance

Phone

(410) 910-1500

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1356459747",
    "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": "3000 EAST COLISEUM BLVD.",
            "address_2": "SUITE 300",
            "city": "FT. WAYNE",
            "state": "IN",
            "postal_code": "46805",
            "telephone_number": "260-432-1166",
            "fax_number": "260-436-3914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "BRICKHOUSE",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "410-910-1500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IN",
            "license": "003757-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164297",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200484160A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2475521",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; 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.