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General NPI Number Information
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NPI Number | 1831324037
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Entity Type | Organization
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Legal Business Name | CYSCO DM HOME HEALTH AGENCY INC
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 2930 W IMPERIAL HWY STE 200F
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City | INGLEWOOD
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State | CA
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Zip | 90303-3142
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Country | US
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Telephone | 323-893-5140
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Fax | 323-779-2322
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Provider Business Mailing Address
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Address Line | 2930 W IMPERIAL HWY STE 200F
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City | INGLEWOOD
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State | CA
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Zip | 90303-3142
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Country | US
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Telephone | 323-893-5140
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Fax | 323-779-2322
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. CYRIACUS C OMEAKU SR.
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Credential |
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Telephone | 323-893-5140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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