Provider Demographics
NPI:1821051608
Name:ALLENDALE ASSOCIATION
Entity Type:Organization
Organization Name:ALLENDALE ASSOCIATION
Other - Org Name:
Other - Org Type:
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 1:600 W GRAND AVE
Mailing Address - Street 2:P.O. BOX 1088
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8034
Mailing Address - Country:US
Mailing Address - Phone:847-356-2351
Mailing Address - Fax:847-356-2393
Practice Address - Street 1:GRAND AVE. AND OFFIELD DR.
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-1088
Practice Address - Country:US
Practice Address - Phone:847-356-2351
Practice Address - Fax:847-356-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0804X, 261QM0801X, 322D00000X
IL001261QM0801X
IL001300-10261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid