Organization
INNOVATIVE CARE NETWORK
Active
Parent organization
INNOVATIVE HEALTH SYSTEMS
Organization subpart
Yes
Provider details
NPI number
Legal business name
INNOVATIVE HEALTH SYSTEMS
Authorized official
RICARDO TILLERY MBA, LCSW, SAP, CCS (AUTHORIZED AGENT)
(517) 515-6176
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
171M00000X
Case Manager/Care Coordinator
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
Other
Enumeration date
05/08/2024
Last updated
05/08/2024
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