Healthcare Provider Details

I. General information

NPI: 1053619528
Provider Name (Legal Business Name): ALLENDALE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W WATER ST
WAUKEGAN IL
60085-5527
US

IV. Provider business mailing address

421 W WATER ST
WAUKEGAN IL
60085-5527
US

V. Phone/Fax

Practice location:
  • Phone: 847-360-9560
  • Fax: 847-360-0195
Mailing address:
  • Phone: 847-360-9560
  • Fax: 847-360-0195

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 Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number110330-09
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