Provider Demographics
NPI:1679611313
Name:MAXFAR, LLC
Entity type:Organization
Organization Name:MAXFAR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-875-7100
Mailing Address - Street 1:10240 W BELL RD STE A
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1153
Mailing Address - Country:US
Mailing Address - Phone:623-875-7100
Mailing Address - Fax:623-875-7101
Practice Address - Street 1:10240 W BELL RD STE A
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1153
Practice Address - Country:US
Practice Address - Phone:623-875-7100
Practice Address - Fax:623-875-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ803166Medicaid
AZ975815OtherAHCCCS PROVIDER
AZ803166OtherAHCCCS PROVIDER
AZ975815Medicare UPIN