Organization
MEDICAB
Active
Organization
MEDICAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICARDO D 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) 481-6270
Mailing address
3721 W MICHIGAN AVE STE 200, LANSING, MI 48917-3600
(517) 481-6270
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
—
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
332U00000X
Home Delivered Meals
—
—
335G00000X
Medical Foods Supplier
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
344600000X
Taxi
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
07/07/2020
Last updated
07/07/2020
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