Provider Demographics
NPI:1013215649
Name:ALLENDALE ASSOCIATION
Entity Type:Organization
Organization Name:ALLENDALE ASSOCIATION
Other - Org Name:BECKER GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCHRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, JD
Authorized Official - Phone:847-245-6214
Mailing Address - Street 1:448 N GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4006
Mailing Address - Country:US
Mailing Address - Phone:847-244-9343
Mailing Address - Fax:847-244-9540
Practice Address - Street 1:448 N GENESEE ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4006
Practice Address - Country:US
Practice Address - Phone:847-244-9343
Practice Address - Fax:847-244-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0804X, 261QM0801X
IL002129-11320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid