OrganizationActive
Independent Life Supportive Services
NPI 1417081167 · Mental Illness Community Based Residential Treatment Facility · Lake Orion, MI
Provider details
- NPI number
- 1417081167
- Entity type
- Organization
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Brad Tankersley, Director of Operations(248) 391-2787
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2912 Ravine Dr
Apt 206
Lake Orion, MI 48360-2392
Phone: (248) 391-2787
Street-level locationGet directions
Mailing address
2912 Ravine Dr
Lake Orion, MI 48360-2392
Registry dates
- Enumerated
- 2007-03-15
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.