MEDICARE: ALLENDALE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1508408378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLENDALE LLC

Provider Business Mailing Address
First Line	:	5419 COUNTY ROAD 427
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-9504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5419 COUNTY ROAD 427
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-9504
Country	:	US
Telephone Number	:	239-888-4190
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ADAM HOCHBERG
Credential	:
Telephone Number	:	833-338-6946

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	03/06/2024

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Directions to “ALLENDALE LLC ” Practice Location

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