Healthcare Provider Details

I. General information

NPI: 1992003578
Provider Name (Legal Business Name): ALLENDALE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 SHERMAN AVE
NORTH CHICAGO IL
60064-2318
US

IV. Provider business mailing address

1920 SHERMAN AVE
NORTH CHICAGO IL
60064-2317
US

V. Phone/Fax

Practice location:
  • Phone: 847-693-2060
  • Fax:
Mailing address:
  • Phone: 847-693-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number501373-01
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

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