Provider Demographics
NPI:1891071775
Name:ACI SUPPORT SPECIALISTS, INC.
Entity Type:Organization
Organization Name:ACI SUPPORT SPECIALISTS, INC.
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:
Authorized Official - Last Name:WADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-861-2000
Mailing Address - Street 1:834 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4850
Mailing Address - Country:US
Mailing Address - Phone:919-861-2000
Mailing Address - Fax:919-861-2001
Practice Address - Street 1:4265 BROWNSBORO RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3425
Practice Address - Country:US
Practice Address - Phone:919-861-2000
Practice Address - Fax:919-861-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3408221251C00000X, 251S00000X
NC322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00000OtherNC DHHS