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General NPI Number Information
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NPI Number | 1144629718
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Entity Type | Organization
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Legal Business Name | TDL GROUP, INC.
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 618 W GOODNER ST
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City | NASHVILLE
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State | IL
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Zip | 62263-1009
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Country | US
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Telephone | 618-464-0161
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Fax | 618-464-0162
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Provider Business Mailing Address
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Address Line | PO BOX 705
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City | MOUNT VERNON
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State | IL
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Zip | 62864-0015
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Country | US
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Telephone | 618-244-7701
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Fax | 618-244-7704
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Authorized Official
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Title or Position | PRESIDENT
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Name | TONYA LINDSEY
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Credential |
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Telephone | 618-244-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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