Provider Demographics
NPI:1750431623
Name:ACI SUPPORT SPECIALISTS, LLC
Entity type:Organization
Organization Name:ACI SUPPORT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-789-5906
Mailing Address - Street 1:1444 NORTHLAND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1032
Mailing Address - Country:US
Mailing Address - Phone:651-699-0206
Mailing Address - Fax:651-699-0799
Practice Address - Street 1:834 TIMBER DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4850
Practice Address - Country:US
Practice Address - Phone:919-861-2000
Practice Address - Fax:919-861-2001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUNGARVIN NORTH CAROLINA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-11
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300977Medicaid
NC3408221Medicaid