Provider Demographics
NPI:1598442998
Name:MEM SCEPTER HOME & BEHAVIORAL
Entity Type:Organization
Organization Name:MEM SCEPTER HOME & BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MODUPE
Authorized Official - Middle Name:OLUFUNKE
Authorized Official - Last Name:ADENEKAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMHNP-BC
Authorized Official - Phone:403-094-0952
Mailing Address - Street 1:PO BOX 1116
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1116
Mailing Address - Country:US
Mailing Address - Phone:240-309-4111
Mailing Address - Fax:240-309-4095
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?:Yes
Parent Organization LBN:MEM SCEPTER HOME & BEHAVIORAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation