Provider Demographics
NPI:1609178656
Name:AC SUPPORT SYSTEMS, LLC
Entity Type:Organization
Organization Name:AC SUPPORT SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIZAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-408-9760
Mailing Address - Street 1:3420 PLUM CRES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2815
Mailing Address - Country:US
Mailing Address - Phone:757-408-9760
Mailing Address - Fax:757-353-4424
Practice Address - Street 1:4412 GLEN LAKE PATH
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4714
Practice Address - Country:US
Practice Address - Phone:757-408-9760
Practice Address - Fax:757-353-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1483-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities