Maxim Healthcare Services, Inc.
Organization Active NPI Home Health Agency · Roseville, CA
NPI 1821289596 · NPPES record last updated Aug 30, 2023
Key facts
- NPI
- 1821289596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- MAXIM HEALTHCARE SERVICES, INC.
- Practice address
- 1478 Stone Point Dr Ste 200
Roseville, CA 95661-2869 - Phone
- (916) 771-7444
- NPI assigned
- Aug 7, 2007
- Organization subpart
- No
Authorized official
- Name
- David Kowalczyk
- Title
- Regional Controller
- Phone
- (410) 910-1500
Corporate family (same tax ID) 24
Facilities with the same owner 69
Medicare Care Compare: Home health agency
- Listed as
- Maxim Healthcare Services, Inc
- Ownership
- Proprietary
- Certified
- Oct 20, 2009
- Medicare certification status
- Active
- Services
- Nursing, Medical social
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1039677 | Maxim Healthcare Services Inc | Certificate of waiver | Jan 28, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Home health agency certification: CCN 059117
- Legal name
- MAXIM HEALTHCARE SERVICES INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Oct 20, 2009
- Last certification
- Nov 26, 2019
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Proprietary
- Incorporated
- Sep 2, 1988 in MD
- Enrollment address
- 1478 Stone Point Dr
Ste 200
Roseville, CA 95661-2869
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Maxim Healthcare Services Inc |
Operational/Managerial Control | Jan 1, 2009 | 100% |
| Joseph W Marshall |
Corporate Director |
Jul 1, 2017 | |
| Randall D Sones |
Corporate Director |
Aug 25, 2009 | |
| Jarrod L Depriest |
Corporate Officer |
Jan 1, 2022 | |
| Matthew Sticklin |
Corporate Officer |
Aug 29, 2022 | |
| David S. Kowalczyk |
W-2 Managing Employee |
Oct 15, 2012 | |
| Toni-Jean L Friedman |
Corporate Officer |
Nov 1, 2009 | |
| Oak Investment Trust |
5% Or Greater Indirect Ownership Interest | Mar 18, 2019 | 38.89% |
| Stephen J Bisciotti |
5% Or Greater Indirect Ownership Interest | Mar 18, 2019 | 19.94% |
| Oak Investment Trust II |
5% Or Greater Indirect Ownership Interest | Mar 18, 2019 | 39.35% |
| Maxim Healthcare Services Holdings, Inc. |
5% Or Greater Direct Ownership Interest | Mar 18, 2019 | 100% |
All facility ownership & control disclosures 26
| Facility | Type | Role | Since |
|---|---|---|---|
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Feb 10, 2012 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Feb 10, 2012 |
| Maxim Healthcare Services Inc |
Home health agency | Other | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Feb 10, 2012 |
| Maxim Healthcare Services Inc |
Home health agency | Other | Jan 9, 2006 |
| Maxim Healthcare Services, Inc. |
Home health agency | Other | Jan 9, 1996 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Feb 10, 2012 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Apr 25, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other | Jan 30, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other | Jan 9, 2006 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Sep 2, 1988 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Jun 1, 2007 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Feb 10, 2012 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Feb 10, 2012 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Dec 4, 2009 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Apr 28, 2010 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Jun 30, 2011 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Jun 30, 2011 |
| Maxim Healthcare Services Inc |
Home health agency | Other (100%) | Jun 30, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090304000667 | CA | Part a Provider - Home Health Agency | 1658288410 | Practice locations: Roseville, CA |
National Provider Directory
- Tax ID family
- Maxim Healthcare Servise
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
1478 Stone Point Dr Ste 200
Roseville, CA 95661-2869
Mailing address
7227 Lee Deforest Dr
Columbia, MD 21046-3236
Phone (410) 910-1500
Other practice location 1
151 N Sunrise Ave
Suite 905
Roseville, CA 95661-2924
Phone (916) 771-7444
Other providers in Roseville, CA
- Onesty Maurice
- Adam Xu Mauricio
- Maverly One LLC
- Annell Mavrantonis-Kruithof
- Maxim Healthcare Services, Inc.
- Rachel Maxim
- Maxview, Inc
- Dave Maxwell
- Jeffery Maxwell
- Olga Maxwell
All providers in Roseville, CA · Home Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.