MEDICARE: REJUVENATION SUPPORT SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	320800000X	Mental Illness Community Based Residential Treatment Facility
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1285580381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REJUVENATION SUPPORT SERVICES, INC

Provider Business Mailing Address
First Line	:	4554 RENIGAR ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-2936
Country	:	US
Telephone Number	:	678-827-1052
Fax Number	:

Provider Business Practice Location Address
First Line	:	4554 RENIGAR ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-2936
Country	:	US
Telephone Number	:	678-827-1052
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. BARBARA STOWE
Credential	:
Telephone Number	:	678-827-1052

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/21/2026

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