Organization
INNOVATIVE ADDICTION SERVICES
Active
Organization
INNOVATIVE ADDICTION SERVICES
Active
Parent organization
INNOVATIVE HEALTH SYSTEMS
Organization subpart
Yes
Provider details
NPI number
Legal business name
INNOVATIVE HEALTH SYSTEMS
Authorized official
MR. RICARDO DAVID TILLERY MBA, LMSW, CAADC (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
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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