Provider Demographics
NPI:1518305960
Name:ACI SUPPORT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ACI SUPPORT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-861-2000
Mailing Address - Street 1:8504 SIX FORKS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3261
Mailing Address - Country:US
Mailing Address - Phone:919-861-2000
Mailing Address - Fax:919-861-2001
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-2722
Practice Address - Country:US
Practice Address - Phone:910-285-1157
Practice Address - Fax:910-285-1171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACI SUPPORT SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X, 251S00000X
NC253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408221Medicaid