Provider Demographics
NPI:1679003792
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 STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3262
Mailing Address - Country:US
Mailing Address - Phone:919-861-2000
Mailing Address - Fax:
Practice Address - Street 1:115 GRANTHAM ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1934
Practice Address - Country:US
Practice Address - Phone:919-861-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACI SUPPORT SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408221Medicaid