Provider Demographics
NPI:1801463971
Name:MAXIM HEALTHCARE
Entity type:Organization
Organization Name:MAXIM HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:THIEL
Authorized Official - Suffix:
Authorized Official - Credentials:BT
Authorized Official - Phone:760-215-2320
Mailing Address - Street 1:2141 PALOMAR AIRPORT RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1451
Mailing Address - Country:US
Mailing Address - Phone:760-438-0078
Mailing Address - Fax:
Practice Address - Street 1:2141 PALOMAR AIRPORT RD STE 350
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1451
Practice Address - Country:US
Practice Address - Phone:760-438-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty