Organization
REJUVENATING LIVES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE KURTINA-JIMEKE BROWN (OWNER)
(919) 916-8100
Entity
Organization
Contact information
Practice address
4913 PROFESSIONAL CT STE 202, RALEIGH, NC 27609-1926
(919) 907-3512
(984) 377-4381
Mailing address
4913 PROFESSIONAL CT STE 202, RALEIGH, NC 27609-1926
(919) 916-8100
(984) 377-4381
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
HC4151
NC
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
305S00000X
Point of Service
HC4151
NC
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
HC4151
NC
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6602070
—
NC
Enumeration date
06/25/2010
Last updated
02/15/2024
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