Maxim Healthcare Services, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

100000500 Issued in CA

Legal business name

MAXIM HEALTHCARE SERVICES, INC.

Practice address

1651 Response Rd Ste 200
Sacramento, CA 95815-5255

Phone

(916) 974-9120

Fax

(916) 974-2588

NPI assigned

Apr 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. David S Kowalczyk

Title

Regional Controller

Phone

(410) 910-1730

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Home health agency certification: CCN 05K134

Legal name

MAXIM HEALTHCARE SERVICES, INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jan 20, 2006

Last certification

Nov 16, 2017

Ownership / control type

Proprietary

Facility address

1651 Response Road, Suite 200
Sacramento, CA 95815

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639353600000",
    "number": "1710940515",
    "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": "1651 RESPONSE RD STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958155255",
            "telephone_number": "916-974-9120",
            "fax_number": "916-974-2588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "REGIONAL CONTROLLER",
        "authorized_official_telephone_number": "410-910-1730",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "100000500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA70277F/05-K017",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zakiahmad Mavli, M.D.
• Megan Maxfield
• Maxicare Hospice Inc
• Maxim Healthcare Services Inc
• Maxim Healthcare Services, Inc.
• Maxim Staffing Solutions
• Annabelle Maxwell
• Deearnest Anthony Maxwell
• Glenn Maxwell, CADC-II, ICADC
• Hannah Jo Maxwell

• Home Health Agency in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.