Organization
INDEPENDENT LIFE SUPPORTIVE SERVICES
Active
Organization
INDEPENDENT LIFE SUPPORTIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD R TANKERSLEY (DIRECTOR OF OPERATIONS)
(248) 391-2787
Entity
Organization
Contact information
Practice address
2912 RAVINE DR, APT 206, LAKE ORION, MI 48360-2392
(248) 391-2787
Mailing address
2912 RAVINE DR, APT 206, LAKE ORION, MI 48360-2392
(248) 391-2787
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/15/2007
Last updated
08/22/2020
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