Provider Demographics
NPI:1740843366
Name:CYSCODM GROUP, LLC
Entity type:Organization
Organization Name:CYSCODM GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:N
Authorized Official - Last Name:OMEAKU
Authorized Official - Suffix:
Authorized Official - Credentials:CSCM
Authorized Official - Phone:747-238-2082
Mailing Address - Street 1:10926 CASIMIR AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2512
Mailing Address - Country:US
Mailing Address - Phone:323-742-9999
Mailing Address - Fax:
Practice Address - Street 1:400 CONTINENTAL BLVD STE 640
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5076
Practice Address - Country:US
Practice Address - Phone:747-238-2082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care