Independent Life Supportive Services
NPI #1417081167 in Lake Orion, Michigan
Provider Information
- NPI Number
- 1417081167
- Entity Type
- Organization
- Organization Name
- Independent Life Supportive Services
- Primary Specialty
- Community Based Residential Treatment Facility, Mental Illness
- Enumeration Date
- Mar 15, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 2912 RAVINE DR
- Address 2
- APT 206
- City
- Lake Orion
- State
- Michigan
- ZIP Code
- 48360-2392
- Phone
- (248) 391-2787
Authorized Official
- Name
- MR. BRAD R TANKERSLEY
- Title
- DIRECTOR OF OPERATIONS
- Phone
- (248) 391-2787
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
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