Revitalize Support Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

REVITALIZE SUPPORT SERVICES, LLC

Practice address

4606 Moravia Run Way
Baltimore, MD 21206-3582

Phone

(443) 619-1222

Fax

(443) 619-1222

NPI assigned

Dec 1, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Irenerenette Ellis

Title

Owner/Administrator/President/Ceo

Phone

(443) 619-1222

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1764547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764547200000",
    "number": "1134081862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4606 MORAVIA RUN WAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212063582",
            "telephone_number": "443-619-1222",
            "fax_number": "443-619-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4606 MORAVIA RUN WAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212063582",
            "telephone_number": "443-619-1222",
            "fax_number": "443-619-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-01",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "IRENERENETTE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR/PRESIDENT/CEO",
        "authorized_official_telephone_number": "443-619-1222"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.