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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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