Provider Demographics
NPI:1831324037
Name:CYSCO DM HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:CYSCO DM HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CYRIACUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:OMEAKU
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:323-893-5140
Mailing Address - Street 1:2930 W IMPERIAL HWY STE 200F
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-3142
Mailing Address - Country:US
Mailing Address - Phone:323-893-5140
Mailing Address - Fax:323-779-2322
Practice Address - Street 1:2930 W IMPERIAL HWY STE 200F
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-3142
Practice Address - Country:US
Practice Address - Phone:323-893-5140
Practice Address - Fax:323-779-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health