Healthcare Provider Details

I. General information

NPI: 1154671030
Provider Name (Legal Business Name): ALLENDALE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 07/21/2022
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 GRAND AVE 101
GURNEE IL
60031-4913
US

IV. Provider business mailing address

5465 GRAND AVE 101
GURNEE IL
60031-4913
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-7177
  • Fax: 847-244-9486
Mailing address:
  • Phone: 847-244-7177
  • Fax: 847-244-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number007
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CHRISTOPHER ANTHONY SCHRANTZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA, JD
Phone: 847-245-6214