Organization
INNOVATIVE BEHAVIORAL HEALTH
Active
Parent organization
INNOVATIVE HEALTH SYSTEMS
Organization subpart
Yes
Provider details
NPI number
Legal business name
INNOVATIVE HEALTH SYSTEMS
Authorized official
RICARDO DAVID TILLERY MBA, LCSW, SAP (CEO)
(517) 703-3387
Entity
Organization
Contact information
Practice address
3721 W MICHIGAN AVE STE 200, LANSING, MI 48917-3600
(517) 515-6176
Mailing address
3721 W MICHIGAN AVE STE 200, LANSING, MI 48917-3600
(517) 515-6176
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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