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Organization Active NPI

Maxim Healthcare Services, Inc.

  • Home Health Agency
  • Chattanooga, TN
National Provider Identifier
1689769820
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
0000000613 Issued in TN
Legal business name
MAXIM HEALTHCARE SERVICES, INC.
Practice address
555 Walnut St Ste 150
Chattanooga, TN 37402-1314
Phone
(423) 553-5530
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Authorized official

Name
David Kowalczyk
Title
Executive Director of Finance
Phone
(410) 910-1730

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 0000000613 TN Primary
Home Health Agency 251E00000X L4380861511 TN

Addresses

Primary practice location

555 Walnut St Ste 150
Chattanooga, TN 37402-1314

Mailing address

7227 Lee Deforest Dr
Columbia, MD 21046-3236
Phone (410) 910-1500

Other identifiers 1

IdentifierTypeStateIssuer
5441954MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070717000210 TN Part A Provider - Home Health Agency 1658288410 Practice locations: Chattanooga, TN

Home health agency certification: CCN 447571

Legal name
MAXIM HEALTHCARE SERVICES INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 23, 2007
Last certification
Jun 13, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Sep 2, 1988 in MD
Enrollment address
555 Walnut St
Ste 150
Chattanooga, TN 37402-1314

Care Compare: Home health agency

Medicare Care Compare
Listed as
Maxim Healthcare ServicesCCN 447571
Ownership
Proprietary
Certified
Oct 23, 2007
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 12

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

Locations

555 Walnut St
Ste 150
Chattanooga, TN 37402
Phone (423) 553-5530

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Joseph W Marshall Individual Corporate DirectorBoard Member Jul 1, 2017
Randall D Sones Individual Corporate DirectorBoard Member Aug 25, 2012
Duane D Brickhouse Individual W-2 Managing EmployeeRegional VP of Finance Oct 15, 2012
Jarrod L Depriest Individual Corporate OfficerPresident Jan 1, 2022
Matthew Sticklin Individual Corporate OfficerCfo Aug 29, 2022
Toni-Jean L Friedman Individual Corporate OfficerVP,General Counsel,Secretary Nov 1, 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%
Spencer O'Neill Individual W-2 Managing EmployeeAdministrator May 11, 2020
Maxim Healthcare Services Holdings, Inc. Organization, Columbia, MD Corporation, Holding company, For-profit, Chain home office 5% Or Greater Direct Ownership Interest Mar 18, 2019 100%

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1689769820",
    "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",
            "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": "555 WALNUT ST STE 150",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374021314",
            "telephone_number": "423-553-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "410-910-1730"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TN",
            "license": "0000000613",
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TN",
            "license": "L4380861511",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5441954",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.