ALLENDALE ASSOCIATION (NPI# 1033417670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033417670 |
| Entity Type | Organization |
| Organization Name | ALLENDALE ASSOCIATION |
| Other Organization Name | BENET LAKE CHILD & ADOLESCENT TREATMENT CENTER |
| Practice Address |
12603 224th Ave Benet Lake WI 53102-1000 |
| Mailing Address |
12603 224th Ave P.o. Box 317 Benet Lake WI 53102-1000 |
| Practice Telephone | 2623969660 |
| Practice Fax Number | 2623964331 |
| Mailing Telephone | 2623969660 |
| Mailing Fax Number | 2623964331 |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2011-03-07 |
| Authorized Official Name | MR. CHRISTOPHER ANTHONY SCHRANTZ (VICE PRESIDENT - FINANCE) |
| Authorized Official Telephone | 8472456214 |
| Authorized Official Credential | CPA, JD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 265024 | WI | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 43016300 | 05 |
| Other Name | Type Code |
|---|---|
| Benet Lake Child & Adolescent Treatment Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053619528 | Allendale Association | Community Based Residential Treatment Facility, Mental Illness | 421 W Water St, Waukegan, IL 60085-5527 | 2011-03-08 |
| 1992003578 | Allendale Association | Residential Treatment Facility, Emotionally Disturbed Children | 1920 Sherman Ave, North Chicago, IL 60064-2318 | 2011-03-07 |
| 1013215649 | Allendale Association | Community Based Residential Treatment Facility, Mental Illness | 448 N Genesee St, Waukegan, IL 60085-4006 | 2011-03-07 |
| 1437457074 | Allendale Association | Community Based Residential Treatment Facility, Mental Illness | 1875 Stratford Rd, Highland Park, IL 60035-3747 | 2011-03-07 |
| 1821051608 | Allendale Association | Clinic/Center | Grand Ave. and Offield Dr., Lake Villa, IL 60046-1088 | 2006-04-11 |
| 1548744972 | Allendale Association | Residential Treatment Facility, Emotionally Disturbed Children | 600 W Grand Ave, Lake Villa, IL 60046-8034 | 2018-09-21 |
| 1801370242 | Allendale Association | Residential Treatment Facility, Emotionally Disturbed Children | 448 N Genesee St, Waukegan, IL 60085-4006 | 2018-09-21 |
| 1447734884 | Allendale Association | Residential Treatment Facility, Emotionally Disturbed Children | 421 W Water St, Waukegan, IL 60085-5527 | 2018-09-21 |
| 1154671030 | Allendale Association | Clinic/Center | 5465 Grand Ave, 101, Gurnee, IL 60031-4913 | 2012-09-18 |
| Street Address |
12603 224TH AVE |
| City | BENET LAKE |
| State | WI |
| Zip Code | 53102-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962555755 | Joellyn Marie Schultz | Social Worker | W62n248 Washington Avenue, Suite #203, Cedarburg, WI 53102 | 2007-01-18 |
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134764103 | Anders Developmental & Transition Home LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3359 N 25th St, Milwaukee, WI 53206-1237 | 2019-11-13 |
| 1689145500 | Oconomowoc Developmental Training Center of Wisconsin LLC | Residential Treatment Facility, Emotionally Disturbed Children | 36100 Genesee Lake School, Oconomowoc, WI 53066 | 2018-12-17 |
| 1366601718 | Mercy Assisted Care Inc | Residential Treatment Facility, Emotionally Disturbed Children | 20 E Court St, Janesville, WI 53545-3976 | 2008-06-02 |
| 1346415445 | Carmelite Home, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1214 Kavanaugh Pl, Wauwatosa, WI 53213-2506 | 2008-04-29 |
| 1861666943 | Tomorrow's Children, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | N3066 Tomorrow's Lane, Waupaca, WI 54981-0192 | 2008-04-18 |
| 1629261086 | Willowglen Academy - Howard | Residential Treatment Facility, Emotionally Disturbed Children | 3959 S 51st St, Milwaukee, WI 53220-2653 | 2007-08-20 |
| 1093908451 | Willowglen Academy - Wilson | Residential Treatment Facility, Emotionally Disturbed Children | 3603 S Business Dr, Sheboygan, WI 53081-7096 | 2007-08-20 |
| 1669670477 | Willowglen Academy-wisconsin, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1111 Reed St, Plymouth, WI 53073-2506 | 2007-07-03 |
| 1457559262 | Willowglen Hein Foster Care Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 207 Hein Ave, Plymouth, WI 53073-2526 | 2007-07-03 |
| 1134327943 | Bell Therapy, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 3018 S 9th St, Milwaukee, WI 53215-3944 | 2007-07-03 |
| Find all providers with the same taxonomy | ||||
| City | BENET LAKE |
| Zip Code | 53102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.