Provider Demographics
NPI:1851107742
Name:MAX HOMECARE LLC
Entity type:Organization
Organization Name:MAX HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-579-6210
Mailing Address - Street 1:4801 W KRALL ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-4165
Mailing Address - Country:US
Mailing Address - Phone:443-579-6210
Mailing Address - Fax:
Practice Address - Street 1:19752 W BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3054
Practice Address - Country:US
Practice Address - Phone:443-579-6210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAX HOMECARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness