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General NPI Number Information
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NPI Number | 1598442998
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Entity Type | Organization
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Legal Business Name | MEM SCEPTER HOME & BEHAVIORAL
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 25484 POINT LOOKOUT RD STE 301A
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City | LEONARDTOWN
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State | MD
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Zip | 20650-3842
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Country | US
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Telephone | 240-309-4111
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Fax | 240-309-4095
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Provider Business Mailing Address
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Address Line | PO BOX 1116
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City | LEONARDTOWN
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State | MD
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Zip | 20650-1116
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Country | US
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Telephone | 240-309-4111
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Fax | 240-309-4095
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Authorized Official
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Title or Position | PRESIDENT
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Name | MODUPE OLUFUNKE ADENEKAN
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Credential | CRNP-PMHNP-BC
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Telephone | 403-094-0952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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