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General NPI Number Information
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NPI Number | 1609178656
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Entity Type | Organization
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Legal Business Name | AC SUPPORT SYSTEMS, LLC
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 4412 GLEN LAKE PATH
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-4714
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Country | US
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Telephone | 757-408-9760
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Fax | 757-353-4424
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Provider Business Mailing Address
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Address Line | 3420 PLUM CRES
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-2815
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Country | US
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Telephone | 757-408-9760
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Fax | 757-353-4424
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Authorized Official
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Title or Position | OWNER
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Name | MR. RIZAL L CRUZ
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Credential |
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Telephone | 757-408-9760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 1483-01-001
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License Number State | VA
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