Organization
MAXCARE HEALTH AND RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MELVIN MAX OLIVER (PROGRAM DIRECTOR)
(804) 366-7605
Entity
Organization
Contact information
Practice address
13900 CEDAR CREEK RD, CHESTERFIELD, VA 23838
(804) 739-5902
Mailing address
13900 CEDAR CREEK RD, CHESTERFIELD, VA 23838-1216
(804) 739-5902
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
2723
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2723-01-001
—
VA
Enumeration date
09/18/2017
Last updated
07/21/2022
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