Provider Demographics
NPI:1972902534
Name:TDL GROUP, INC.
Entity Type:Organization
Organization Name:TDL GROUP, INC.
Other - Org Name:IMAGE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-244-7701
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0015
Mailing Address - Country:US
Mailing Address - Phone:618-244-7701
Mailing Address - Fax:618-244-7704
Practice Address - Street 1:11917 E DIANA RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-8873
Practice Address - Country:US
Practice Address - Phone:618-204-5489
Practice Address - Fax:618-204-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities