Provider Demographics
NPI:1811269723
Name:A.C.E. COMMUNITY SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:A.C.E. COMMUNITY SUPPORT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KALIQUE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WOODBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-401-4596
Mailing Address - Street 1:1238 POWERS FERRY CMN SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6046
Mailing Address - Country:US
Mailing Address - Phone:678-401-4596
Mailing Address - Fax:678-401-3126
Practice Address - Street 1:1238 POWERS FERRY CMN SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6046
Practice Address - Country:US
Practice Address - Phone:678-401-4596
Practice Address - Fax:678-401-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA314877275CMedicaid
GA341877275BMedicaid
GA341877275AMedicaid