MEDICARE: CYSCODM GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1740843366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYSCODM GROUP, LLC

Provider Business Mailing Address
First Line	:	10926 CASIMIR AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90303-2512
Country	:	US
Telephone Number	:	323-742-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CONTINENTAL BLVD STE 640
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-5076
Country	:	US
Telephone Number	:	747-238-2082
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. MARGARET N OMEAKU
Credential	:	CSCM
Telephone Number	:	747-238-2082

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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