NPIMap

Organization Active NPI

Maxim Healthcare Services, Inc.

  • Home Health Agency
  • Gardena, CA
National Provider Identifier
1679506398
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
980000985 Issued in CA
Legal business name
MAXIM HEALTHCARE SERVICES, INC.
Practice address
879 W 190TH St Ste 1000
Gardena, CA 90248-4255
Phone
(310) 329-9115
NPI assigned
Jul 8, 2006
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Mr. David S. Kowalczyk
Title
VP of Finance
Phone
(410) 910-1730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 980000985 CA Primary

Addresses

Primary practice location

879 W 190TH St Ste 1000
Gardena, CA 90248-4255

Mailing address

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

Other practice location 1

1515 W 190th St
Suite 155
Gardena, CA 90248-4319
Phone (310) 329-9115

Other identifiers 1

IdentifierTypeStateIssuer
HHA57666HMedicaidCA

National Provider Directory

National Provider Directory

Locations

1515 W 190th St
Ste 155
Gardena, CA 90248
Phone (310) 329-9115

1515 W 190th St
Ste 300
Gardena, CA 90248
Phone (310) 819-4523

879 W 190th St
Ste 1000
Gardena, CA 90248
Phone (310) 329-9115

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1712102400000",
    "number": "1679506398",
    "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": "879 W 190TH ST STE 1000",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484255",
            "telephone_number": "310-329-9115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 W 190th St",
            "address_2": "Suite 155",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902484319",
            "country_code": "US",
            "telephone_number": "310-329-9115",
            "fax_number": "310-329-1147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "410-910-1730",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980000985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA57666H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.