Provider Demographics
NPI:1487989901
Name:MAXIMUM HEALTH CARE REGISTRY INC
Entity type:Organization
Organization Name:MAXIMUM HEALTH CARE REGISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-977-8883
Mailing Address - Street 1:135-13 HOOK CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422
Mailing Address - Country:US
Mailing Address - Phone:718-997-7883
Mailing Address - Fax:718-977-9748
Practice Address - Street 1:135-13 HOOK CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422
Practice Address - Country:US
Practice Address - Phone:718-997-7883
Practice Address - Fax:718-977-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9075L163W00000X, 374U00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01220180Medicaid