Healthcare Provider Details

I. General information

NPI: 1750431623
Provider Name (Legal Business Name): ACI SUPPORT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 TIMBER DR
GARNER NC
27529-4850
US

IV. Provider business mailing address

1444 NORTHLAND DR STE 200
MENDOTA HEIGHTS MN
55120-1032
US

V. Phone/Fax

Practice location:
  • Phone: 919-861-2000
  • Fax: 919-861-2001
Mailing address:
  • Phone: 651-699-0206
  • Fax: 651-699-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8300977
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier3408221
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: LORI KRESS
Title or Position: CEO
Credential:
Phone: 651-789-5906