Provider Demographics
NPI:1508591009
Name:THE CSK VENTURE GROUP, INC.
Entity Type:Organization
Organization Name:THE CSK VENTURE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-321-0006
Mailing Address - Street 1:2121 NEWMARKET PKWY SE STE 122
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9309
Mailing Address - Country:US
Mailing Address - Phone:770-321-0006
Mailing Address - Fax:
Practice Address - Street 1:2121 NEWMARKET PKWY SE STE 122
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9309
Practice Address - Country:US
Practice Address - Phone:770-321-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies