| Mem Scepter Home & Behavioral Health Care Llc | |
|
25484 Point Lookout Rd Ste 301a Leonardtown MD 20650-3842 | |
| (240) 309-4111 | |
| (240) 309-4095 |
| Full Name | Mem Scepter Home & Behavioral Health Care Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 25484 Point Lookout Rd Ste 301a, Leonardtown, Maryland |
| Authorized Official Name and Position | Modupe O Adenekan (PRESIDENT) |
| Authorized Official Contact | 2024490001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mem Scepter Home & Behavioral Health Care Llc 14104 Dawn Whistle Way Bowie MD 20721-1304 Ph: (202) 449-0001 | Mem Scepter Home & Behavioral Health Care Llc 25484 Point Lookout Rd Ste 301a Leonardtown MD 20650-3842 Ph: (240) 309-4111 |
| NPI Number | 1407462559 |
|---|---|
| Provider Enumeration Date | 09/23/2020 |
| Last Update Date | 06/28/2023 |
| Certification Date | 06/28/2023 |
| Medicare PECOS PAC ID | 1355753765 |
|---|---|
| Medicare Enrollment ID | O20201209000068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407462559 | NPI | - | NPPES |
| Provider Name | Modupe Olufunke Adenekan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790340859 PECOS PAC ID: 8527470939 Enrollment ID: I20201209000095 |
| Provider Name | Mujidat B Obaro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518602168 PECOS PAC ID: 8921470089 Enrollment ID: I20230217002783 |
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