Provider Demographics
NPI:1407686926
Name:ST STEPHEN MEMORY CARE
Entity type:Organization
Organization Name:ST STEPHEN MEMORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TUNJI
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ADEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-529-5342
Mailing Address - Street 1:14515 BRIAR FOREST DR APT 425
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2076
Mailing Address - Country:US
Mailing Address - Phone:346-529-5342
Mailing Address - Fax:
Practice Address - Street 1:5309 PAGEWOOD LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-7226
Practice Address - Country:US
Practice Address - Phone:832-274-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home