Organization
REVITALIZE SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRENERENETTE ELLIS (OWNER/ADMINISTRATOR/PRESIDENT/CEO)
(443) 619-1222
Entity
Organization
Contact information
Practice address
4606 MORAVIA RUN WAY, BALTIMORE, MD 21206-3582
(443) 619-1222
(443) 619-1222
Mailing address
4606 MORAVIA RUN WAY, BALTIMORE, MD 21206-3582
(443) 619-1222
(443) 619-1222
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/01/2025
Last updated
12/01/2025
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