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General NPI Number Information
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NPI Number | 1306686076
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Entity Type | Organization
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Legal Business Name | INNOVATIVE INTEGRATED HEALTH SYSTEMS
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 3721 W MICHIGAN AVE STE 200
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City | LANSING
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State | MI
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Zip | 48917-3600
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Country | US
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Telephone | 517-515-6176
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Fax |
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Provider Business Mailing Address
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Address Line | 3721 W MICHIGAN AVE STE 200
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City | LANSING
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State | MI
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Zip | 48917-3600
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Country | US
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Telephone | 517-515-6176
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RICARDO TILLERY
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Credential | MBA, LCSW
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Telephone | 517-703-3387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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