Organization
INNOVATIVE CHILD & FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICARDO DAVID TILLERY LMSW (CEO)
(517) 703-3387
Entity
Organization
Contact information
Practice address
3721 W MICHIGAN AVE, LANSING, MI 48917-3693
(517) 515-6176
Mailing address
3721 W MICHIGAN AVE, LANSING, MI 48917-3693
(517) 515-6176
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
261QM3000X
Medically Fragile Infants and Children Day Care
—
—
311Z00000X
Custodial Care Facility
—
—
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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