MEDICARE: ALLENDALE ASSOCIATION

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	2084P0804X	Child & Adolescent Psychiatry Physician
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	501373-01	IL
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1992003578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLENDALE ASSOCIATION

Provider Business Mailing Address
First Line	:	1920 SHERMAN AVE
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-2317
Country	:	US
Telephone Number	:	847-693-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 SHERMAN AVE
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-2318
Country	:	US
Telephone Number	:	847-693-2060
Fax Number	:

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

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	05/12/2021

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