Provider Demographics
NPI:1407462559
Name:MEM SCEPTER HOME & BEHAVIORAL
Entity Type:Organization
Organization Name:MEM SCEPTER HOME & BEHAVIORAL
Other - Org Name:MEM SCEPTER HOME & BEHAVIORAL HEALTH CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MODUPE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADENEKAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:202-449-0001
Mailing Address - Street 1:14104 DAWN WHISTLE WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1304
Mailing Address - Country:US
Mailing Address - Phone:202-449-0001
Mailing Address - Fax:
Practice Address - Street 1:25484 POINT LOOKOUT RD STE 301A
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3842
Practice Address - Country:US
Practice Address - Phone:240-309-4111
Practice Address - Fax:240-309-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty