wisconsin community substance abuse program … · adams/friendship elementary school, 500 n pierce...

172
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Community Substance Abuse Program Certification Directory By County, City, and Provider Name ADAMS FRIENDSHIP 2810 ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES Surveyor: Central Office Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 02/28/2019 03/01/2017 12/10/2008 (608) 339-4585 (608) 339-4505 [email protected] ALLISON ELSE County: Adams FRIENDSHIP, WI 53934 108 E NORTH STREET CCS Affiliaton: 01/01/2016 Begin: End: Lead: Central Wisconsin Health Partnership V2 Service Begin / End Dates Adm Code CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2017 02/28/2019 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 03/01/2017 02/28/2019 Services NO BRANCH LOCATIONS 1253 ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT Surveyor: Central Office Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 02/29/2020 03/01/2018 09/01/1990 (608) 339-4585 (608) 339-4323 [email protected] KAY SAARINEN-BARR County: Adams FRIENDSHIP, WI 53934 108 E NORTH STREET Service Begin / End Dates Adm Code CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2018 02/29/2020 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2018 02/29/2020 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2018 02/29/2020 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2018 02/29/2020 Services Setting Begin / End Dates Non - Certified School Setting ( s ) 03/01/2018 02/29/2020 ADAMS/FRIENDSHIP ELEMENTARY SCHOOL, 500 N PIERCE ST, ADAMS, WI 53910 03/01/2018 02/29/2020 ADAMS/FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 53910 03/01/2018 02/29/2020 ADAMS/FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 53910 ASHLAND ASHLAND 2728 BAD RIVER AODA PROGRAM Surveyor: Polly Wong Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 02/28/2019 03/01/2017 02/01/2007 (715) 685-7857 (715) 682-7137 [email protected] LAURA MOORE County: Ashland ASHLAND, WI 54806 53585 NOKOMIS RD Service Begin / End Dates Adm Code CSAS-DAY TREATMENT DHS 75.12 03/01/2017 02/28/2019 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019 Services NO BRANCH LOCATIONS 06/26/2018 Page 1 of 172

Upload: phungnhu

Post on 08-Jun-2018

214 views

Category:

Documents


0 download

TRANSCRIPT

DEPARTMENT OF HEALTH SERVICESDivision of Quality Assurance

STATE OF WISCONSINBureau of Health Services

PO Box 2969Madison, WI 53701-2969

Community Substance AbuseProgram Certification DirectoryBy County, City, and Provider Name

ADAMSFRIENDSHIP

2810ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201712/10/2008

(608) 339-4585

(608) [email protected] ELSE

County: AdamsFRIENDSHIP, WI 53934108 E NORTH STREET

CCS Affiliaton: 01/01/2016Begin: End: Lead:Central Wisconsin Health Partnership V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2017 02/28/2019

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

1253ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201809/01/1990

(608) 339-4585

(608) [email protected] SAARINEN-BARR

County: AdamsFRIENDSHIP, WI 53934108 E NORTH STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2018 02/29/2020

Services

Setting Begin/End DatesNon-Certified School Setting(s)03/01/2018 02/29/2020ADAMS/FRIENDSHIP ELEMENTARY SCHOOL, 500 N PIERCE ST, ADAMS, WI 53910

03/01/2018 02/29/2020ADAMS/FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 53910

03/01/2018 02/29/2020ADAMS/FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 53910

ASHLANDASHLAND

2728BAD RIVER AODA PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201702/01/2007

(715) 685-7857

(715) [email protected] MOORE

County: AshlandASHLAND, WI 5480653585 NOKOMIS RD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2017 02/28/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 1 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2154BEHAVIORAL HEALTH SERVICES OF MEMORIAL MEDICAL CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201710/01/1999

(715) 685-5102

(715) [email protected] JENSEN

County: AshlandASHLAND, WI 548061635 MAPLE LANE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/01/2017 09/30/2019

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2017 09/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/2017 09/30/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 10/01/2017 09/30/2018

MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2017 09/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2017 09/30/2019ASHLAND MIDDLE SCHOOL, 203 - 11TH STREET EAST, ASHLAND, WI 548063

10/01/2017 09/30/2019DRUMMOND AREA SCHOOL DISTRICT, 52440 EASTERN AVE, DRUMMOND, WI 548323

10/01/2017 09/30/2019LAKE SUPERIOR PRIMARY SCHOOL DISTRICT, 1101 BINSFIELD ROAD, ASHLAND, WI 548063

10/01/2017 09/30/2019NORTHLAND COLLEGE, 1411 ELLIS AVE, ASHLAND, WI 548063

3055NEW HORIZONS NORTH CCS - ASHLAND COUNTY

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/01/2015

(715) [email protected] LEVNO

County: AshlandASHLAND, WI 54806514 WEST MAIN STREET

CCS Affiliaton: 01/01/2015Begin: End: Lead:New Horizons North CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

1664NEW HORIZONS NORTH-COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201705/13/1991

(715) 682-7176

(715) [email protected] LEVNO

County: AshlandASHLAND, WI 54806514 W MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 2 of 172

Substance Abuse Program Directory By County, City, and Provider Name

BARRONBARRON

2640BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201701/01/2006

(715) 537-6848

(715) [email protected] HAY

County: BarronBARRON, WI 54812335 EAST MONROE AVE ROOM 338

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

RICE LAKE

2925BARRON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201711/01/2010

(715) 537-6848

(715) [email protected] HAY

County: BarronRICE LAKE, WI 54868935 N MAIN ST, LOWER LEVEL

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 11/01/2017 10/31/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 3 of 172

Substance Abuse Program Directory By County, City, and Provider Name

BAYFIELDBAYFIELD

3157RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA CCS

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201804/01/201804/01/2017

(715) 779-3765

(715) [email protected] GURNOE

County: BayfieldBAYFIELD, WI 5481437390 NORTH BRADUM ROAD

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 04/01/2018 09/30/2018

Services

NO BRANCH LOCATIONS

3143RED CLIFF COMMUNITY HEALTH CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201805/20/2016

(715) 779-3362

(715) [email protected] GURNOE

County: BayfieldBAYFIELD, WI 5481436745 AIKEN ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2018 03/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2019MISHOMIS WELLNESS CENTER, 37390 N BRADUM ROAD, BAYFIELD, WI 548142

04/01/2018 03/31/2019RED CLIFF EARLY EDUCATION CENTER, 89830 TINY TOT DRIVE, BAYFIELD, WI 548143

06/26/2018 Page 4 of 172

Substance Abuse Program Directory By County, City, and Provider Name

IRON RIVER

1064NORTHLAKES COMMUNITY CLINIC AODA SERVICES

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201609/01/1984

(715) 372-5067

(715) [email protected] AKL

County: BayfieldIRON RIVER, WI 548477665 US HWY 2

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier05/16/2018 08/31/2018NORTHLAKES CLINIC - HAYWARD RIVERS EDGE, 15954 RIVERS EDGE DR, #121, HAYWARD, WI

548432

12/21/2016 08/31/2018NORTHLAKES COMMUNITY CLINIC - DOWNTOWN, 300 MAIN STREET WEST, ASHLAND, WI 548062

09/01/2016 08/31/2018NORTHLAKES COMMUNITY CLINIC - WASHBURN, 101 THOMPSON ROAD, WASHBURN, WI 548912

09/01/2016 08/31/2018NORTHLAKES COMMUNITY CLINIC, 214-A MAPLE ST SOUTH, TURTLE LAKE, WI 548892

09/01/2016 08/31/2018NORTHLAKES COMMUNITY CLINIC-MINONG MEDICAL CLINIC, 600 SHELL CREEK ROAD, MINONG, WI 54859

2

09/01/2016 08/31/2018ASHLAND HIGH SCHOOL, 1900 BEASER AVENUE, ASHLAND, WI 548063

09/01/2016 08/31/2018ASHLAND MIDDLE SCHOOL, 203 - 11TH STREET EAST, ASHLAND, WI 548063

08/24/2017 08/31/2018CLAYTON SCHOOL, 236 POLK AVENUE WEST, CLAYTON, WI 540043

08/24/2017 08/31/2018CLEAR LAKE JR/SR HIGH SCHOOL, 1101 THIRD ST SW, CLEAR LAKE, WI 540053

09/01/2016 08/31/2018LAKE SUPERIOR PRIMARY AND ELEMENTARY SCHOOLS, 1101 BINSFIELD ROAD, ASHLAND, WI 54806

3

08/24/2017 08/31/2018PRAIRIE FARM SCHOOL, 630 RIVER AVE S, PRAIRIE FARM, WI 547623

08/24/2017 08/31/2018TURTLE LAKE SCHOOL DISTRICT, 205 OAK STREET NORTH, TURTLE LAKE, WI 548893

12/27/2017 08/31/2018WASHBURN ELEMENTARY SCHOOL/ELC, 411 W 8TH STREET, WASHBURN, WI 548913

12/17/2017 08/31/2018WASHBURN MIDDLE/HIGH SCHOOL, 305 4TH AVENUE WEST, WASHBURN, WI 548913

08/24/2017 08/31/2018WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVE, BARRON, WI 548123

WASHBURN

3054NEW HORIZONS NORTH CCS - BAYFIELD COUNTY

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/01/2015

(715) 373-6130

(715) [email protected] LEVNO

County: BayfieldWASHBURN, WI 54891324 WEST BAYFIELD STREET

CCS Affiliaton: 01/01/2015Begin: End: Lead:New Horizons North CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

1663NEW HORIZONS NORTH-COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201703/01/1991

(715) 373-2203

(715) [email protected] LEVNO

County: BayfieldWASHBURN, WI 54891320 WEST SUPERIOR AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 5 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2361NORTHLAND COUNSELING SERVICES

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201807/01/201607/01/2001

(715) 373-0162

(715) [email protected] LUND

County: BayfieldWASHBURN, WI 5489121 W OMAHA STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2016 06/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2016 06/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2016 06/30/2018NORTHLAND COUNSELING SERVICES LTD, 117 EAST SIXTH STREET, WASHBURN, WI 548911

07/01/2016 06/30/2018NORTHLAND COUNSELING SERVICES, 611 E WALL STREET, EAGLE RIVER, WI 545211

07/01/2016 06/30/2018NORTHLAND COUNSELING SERVICES, 1619 WEST THIRD STREET, ASHLAND, WI 548062

06/26/2018 Page 6 of 172

Substance Abuse Program Directory By County, City, and Provider Name

BROWNGREEN BAY

3029ACS CLINICAL SERVICES, LLC - GREEN BAY

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/16/2014

(920) 469-2580

(920) [email protected] SUMNER

County: BrownGREEN BAY, WI 543112670 UNIVERSITY AVE

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3047BAETEN COUNSELING & CONSULTATION TEAM, S.C

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201708/06/2014

(920) 632-4315

(920) [email protected] BAETEN

County: BrownGREEN BAY, WI 543012920 S WEBSTER AVE, SUITE B

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 7 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1098BELLIN PSYCHIATRIC CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/1984

(920) 431-0333

(920) [email protected] COUNARD

County: BrownGREEN BAY, WI 54301301 E ST JOSEPH STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 04/01/2018 03/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2018 03/31/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 04/01/2018 03/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER - ALGOMA, 831 PARKER ST, ALGOMA, WI 542011

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER - BONDUEL, 401 E MILL ST, BONDUEL, WI 541071

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER - BRILLION, 964 W. RYAN ST., STE. B, BRILLION, WI 541101

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER, 575 - 4TH ST, KEWAUNEE, WI 542161

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER, 704 S. WEBSTER STE. #201, GREEN BAY, WI 543011

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER, 744 S WEBSTER AVE, GREEN BAY, WI 543011

04/01/2018 03/31/2020BELLIN HEALTH GENERATIONS, 720 S VAN BUREN ST #101, GREEN BAY, WI 543012

04/01/2018 03/31/2020BELLIN HEALTH RIVERSIDE PSYCHIATRIC GROUP, 1325 ANGELS PATH, DE PERE, WI 541152

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER - EAST DE PERE, 555 REDBIRD CIRCLE STE 100, DE PERE, WI 541152

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER - OCONTO FALLS, 107 E HIGHLAND DR, OCONTO FALLS, WI 541542

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER - STURGEON BAY, 311 N 3RD AVENUE, STURGEON BAY, WI 542352

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER-NEURO TEAM, 725 S WEBSTER, GREEN BAY, WI 543052

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER-W. DE PERE, 1800 LAWRENCE DR, DE PERE, WI 541152

04/01/2018 03/31/2020ALGOMA ELEMENTARY SCHOOL, 514 FREEMONT STREET, ALGOMA, WI 542013

04/01/2018 03/31/2020ALGOMA MIDDLE AND HIGH SCHOOL, 1715 DIVISION STREET, ALGOMA, WI 542013

04/01/2018 03/31/2020DR. ROSA MINOKA-HILL SCHOOL, 325 N ROOSEVELT, GREEN BAY, WI 543013

04/01/2018 03/31/2020HEMLOCK CREEK ELEMENTARY SCHOOL, 1900 WILLIAMS GRANT DR, DE PERE, WI 541153

04/01/2018 03/31/2020PHANTOM KNIGHT CHARTER - WEST ACADEMY, 400 REID ST, SUITE W, DE PERE, WI 541153

04/01/2018 03/31/2020WESTWOOD ELEMENTARY SCHOOL, 1155 WESTWOOD, DE PERE, WI 541153

2615BROWN COUNTY COMMUNITY TREATMENT CENTER COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201608/25/2005

(920) 391-4811

(920) [email protected] AGAR

County: BrownGREEN BAY, WI 543113150 GERSHWIN DRIVE

CCS Affiliaton: 01/01/2018Begin: End: Lead:Northeastern Regional CCS Consortium V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2016 08/31/2018

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 8 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1117BROWN COUNTY COMMUNITY TREATMENT CTR

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201710/01/1975

(920) 391-4811

(920) [email protected] AGAR

County: BrownGREEN BAY, WI 543113150 GERSHWIN DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2017 08/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2017 08/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2017 08/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 09/01/2017 08/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2017 08/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2019BROWN COUNTY HUMAN SVS YOUTH CLINIC, 111 NORTH JEFFERSON ST, GREEN BAY, WI 543052

2936BROWN COUNTY HUMAN SERVICES - DIVERSION

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/01/2011

(920) 448-6197

(920) [email protected] AGAR

County: BrownGREEN BAY, WI 543111311 DANZ AVE

Service Begin/End DatesAdm Code

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

2381BROWN COUNTY HUMAN SERVICES-CSP BROWN COUNTY COMMUNITY TREATMENT CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201706/24/2002

(920) 391-4811

(920) [email protected] AGAR

County: BrownGREEN BAY, WI 543113150 GERSHWIN DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 09/01/2017 08/31/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 9 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1329FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201801/12/1996

(920) 432-5966

(920) [email protected] MISCHLER

County: BrownGREEN BAY, WI 54301300 CROOKS STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020BILLIE KRESS CENTER - YOUTH DEVELOPMENT, 3430 SPIRIT WAY, GREEN BAY, WI 543041

04/01/2018 03/31/2020FAMILY SERVICES - SOUTH IRWIN, 626 S IRWIN AVENUE, GREEN BAY, WI 543011

04/01/2018 03/31/2020WILLOW TREE, 503 S MONROE STREET, GREEN BAY, WI 543011

04/01/2018 03/31/2020EAST HIGH SCHOOL, 1415 E WALNUT ST, GREEN BAY, WI 543013

04/01/2018 03/31/2020WRIGHTSTOWN HIGH SCHOOL, 600 HIGH ST, WRIGHTSTOWN, WI 541803

04/01/2018 03/31/2020WRIGHTSTOWN MIDDLE SCHOOL, 400 SCHOOL ST, WRIGHTSTOWN, WI 541803

1035FOUNDATIONS HEALTH AND WHOLENESS

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/01/1981

(920) 437-1188

(920) [email protected] FELD

County: BrownGREEN BAY, WI 543031061 W MASON ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020BOYS AND GIRLS CLUB, 1451 UNIVERSITY AVE, GREEN BAY, WI 543011

05/01/2018 04/30/2020BOYS AND GIRLS CLUB, 311 S. ONEIDA ST, GREEN BAY, WI 543031

05/01/2018 04/30/2020HOUSE OF HOPE, 1660 CHRISTIANA ST., GREEN BAY, WI 543031

05/01/2018 04/30/2020MICAH CENTER, 700 E. WALNUT ST., GREEN BAY, WI 543011

05/01/2018 04/30/2020NEW COMMUNITY CLINIC - NWTC, 2740 W. MASON ST., GREEN BAY, WI 543071

05/01/2018 04/30/2020NEW COMMUNITY CLINIC, 622 BODART ST, GREEN BAY, WI 543011

05/01/2018 04/30/2020NEW COMMUNITY SHELTER, 301 MATHER ST, GREEN BAY, WI 543011

05/01/2018 04/30/2020OUTREACH HEALTHCARE, 879 MATHER ST., GREEN BAY, WI 543031

Setting Begin/End DatesNon-Certified School Setting(s)05/01/2018 04/30/2020ALDO LEOPOLD SCHOOL, 1622 ELIZA ST, GREEN BAY, WI 54301

05/01/2018 04/30/2020BAY VIEW MIDDLE SCHOOL, 1217 CARDINAL LANE, GREEN BAY, WI 54313

05/01/2018 04/30/2020LINEVILLE INTERMEDIAE SCHOOL, 2706 LINEVILLE ROAD, GREEN BAY, WI 54313

2313INDEPENDENT ASSESSMENT & COUNSELING SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201807/01/201606/22/2001

(920) 438-7993

(920) [email protected] SANN

County: BrownGREEN BAY, WI 543031345 W MASON STREET, #201

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2016 06/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2016 06/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 10 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2988JACKIE NITSCHKE CENTER, INC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/24/201801/01/2013

(920) 435-2580

(920) [email protected] JOHNSEN

County: BrownGREEN BAY, WI 54301621 E WALNUT STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/24/2018 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/24/2018 12/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier01/24/2018 12/31/2018JACKIE NITSCHKE CENTER, INC. ADMIN OFFICES & FAM E, 700 CHERRY STREET, GREEN BAY, WI

543011

1446JACKIE NITSCHKE CENTER, INC.

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201706/05/1990

(920) 435-2580

(920) [email protected] JOHNSEN

County: BrownGREEN BAY, WI 54301630 CHERRY STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

1454KA'NI KUHLI'YO FAMILY CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201703/11/1993

(920) 490-3883

(920) [email protected] KRIESCHER

County: BrownGREEN BAY, WI 543032640 WEST POINT ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2017 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2017 01/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2017 01/31/2019ANNA JOHN RESIDENT CENTERED CARE COMMUNITY, 2901 S OVERLAND, ONEIDA, WI 541551

02/01/2017 01/31/2019ONEIDA COMMUNITY HEALTH CENTER, 525 AIRPORT DRIVE, ONEIDA, WI 541551

02/01/2017 01/31/2019ONEIDA NATION VETERAN'S DEPARTMENT, 134 RIVERDALE DR., ONEIDA, WI 541551

02/01/2017 01/31/2019SEYMOUR HIGH SCHOOL SYSTEM, 10 CIRCLE DRIVE, SEYMOUR, WI 541651

02/01/2017 01/31/2019ONEIDA NATION ELEMENTARY SCHOOL, N7125 SEMINARY ROAD, ONEIDA, WI 541553

02/01/2017 01/31/2019ONEIDA NATION HIGH SCHOOL, N7210 SEMINARY ROAD, ONEIDA, WI 541553

12/01/2017 01/31/2019SEYMOUR HIGH SCHOOL SYSTEM, 10 CIRCLE DRIVE, SEYMOUR, WI 541653

1669NEW WELLNESS ASSOCIATES, INC.

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201706/01/1993

(920) 497-3135

(920) [email protected] HOWARD

County: BrownGREEN BAY, WI 543042733 S. RIDGE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2017 05/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2017 05/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2017 05/31/2019NEW WELLNESS ASSOCIATES, INC., 1941 LEHRER LN, KAUKAUNA, WI 541301

06/26/2018 Page 11 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2487QUALITY ADDICTION MANAGEMENT, INC DBA GREEN BAY COMPREHENSIVE TREATMENT CTR

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201610/20/2003

(920) 337-6741

(920) [email protected] NEERDAELS

County: BrownGREEN BAY, WI 543032357 W MASON ST

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

3116ST VINCENT HHS OF THE THIRD ORDER OF ST FRANCIS DBA LIBERTAS

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/2016

(920) 431-1996

(920) [email protected] DOXTATOR

County: BrownGREEN BAY, WI 543031701 DOUSMAN ST

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2017 02/28/2019

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 03/01/2017 02/28/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

1965VILLA HOPE COMMUNITY SUPPORT PROGRAM OF BROWN COUNTY

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/06/1996

(920) 469-5599

(920) [email protected] TOONEN

County: BrownGREEN BAY, WI 543111100 GUNS ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 12 of 172

Substance Abuse Program Directory By County, City, and Provider Name

BURNETTSIREN

2633ACCESS INC COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/01/2006

(715) 349-7205

(715) [email protected] WOLF

County: BurnettSIREN, WI 5487224248 STATE ROAD 35/70 UNIT D

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 01/01/2018 12/31/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

WEBSTER

2217ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2000

(715) 349-8528

(715) [email protected] CORMELL

County: BurnettWEBSTER, WI 548934404 STATE RD 70

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020ROUND LAKE CLINIC, 2230 - 60TH AVENUE, LUCK, WI 548531

06/26/2018 Page 13 of 172

Substance Abuse Program Directory By County, City, and Provider Name

CALUMETCHILTON

1120CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201810/01/1975

(920) 849-1468

(920) [email protected] LECLAIR

County: CalumetCHILTON, WI 53014206 COURT STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2018 06/30/2020

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020CALUMET COUNTY DEPT OF HUMAN SERVICES, 2306 S. ONEIDA STREET, APPLETON, WI 549152

2244CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2000

(920) 849-1468

(920) [email protected] LECLAIR

County: CalumetCHILTON, WI 53014206 COURT STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 07/01/2018 06/30/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

2674CALUMET COUNTY DEPT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201706/13/2006

(920) 849-1468

(920) [email protected] LECLAIR

County: CalumetCHILTON, WI 53014206 COURT STREET

CCS Affiliaton: 09/01/2014Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2017 06/30/2019

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 14 of 172

Substance Abuse Program Directory By County, City, and Provider Name

CHIPPEWACHIPPEWA FALLS

2896CHIPPEWA AREA RECOVERY RESOURCE, LSS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/09/2010

(715) 726-9055

(715) [email protected] RODE

County: ChippewaCHIPPEWA FALLS, WI 54729127 WEST CENTRAL ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2017 02/28/2019CHIPPEWA AREA RECOVERY RESOURCE, 122 S BARSTOW ST SUITE #1, EAU CLAIRE, WI 547011

2744COMMUNITY COUNSELING SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201608/14/2007

(715) 738-1214

(715) [email protected] ESLINGER

County: ChippewaCHIPPEWA FALLS, WI 5472916947 COUNTY HIGHWAY X

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 08/01/2016 07/31/2018

Services

NO BRANCH LOCATIONS

1475ST. JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/12/1977

(715) 717-7504

(715) [email protected] SIMONSON

County: ChippewaCHIPPEWA FALLS, WI 547292661 COUNTY HIGHWAY I

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 02/01/2018 01/31/2020

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 02/01/2018 01/31/2020

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 02/01/2018 01/31/2020

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 02/01/2018 01/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 01/31/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

3064WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM - CSP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2015

(715) 726-7736

(715) [email protected] IVES

County: ChippewaCHIPPEWA FALLS, WI 54729711 N BRIDGE STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 05/01/2018 04/30/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI

546101

05/01/2018 04/30/2020PEPIN COUNTY DEPT OF HUMAN SERVICES, 740 - 7TH AVE. WEST, DURAND, WI 547361

06/26/2018 Page 15 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3065WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM-CCS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201804/01/2015

(715) 726-7736

(715) [email protected] IVES

County: ChippewaCHIPPEWA FALLS, WI 54729711 N BRIDGE STREET

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 04/01/2018 03/31/2019

CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 36 04/01/2018 03/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2019BARRON COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 335 E. MONROE AVE., BARRON, WI

548122

04/01/2018 03/31/2019BUFFALO COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 407 S SECOND ST, ALMA, WI 546102

04/01/2018 03/31/2019DUNN COUNTY DEPT OF HUMAN SERVICES, 3001 US HWY 12 E., STE. 160, MENOMONIE, WI 547512

04/01/2018 03/31/2019PEPIN COUNTY DEPT OF HUMAN SERVICES, 740 7TH AVE WEST, DURAND, WI 547362

04/01/2018 03/31/2019PIERCE COUNTY DEPT OF HUMAN SERVICES, 412 W. KINNE STREET, ELLSWORTH, WI 540112

04/01/2018 03/31/2019POLK COUNTY HUMAN SERVICES DEPARTMENT, 100 POLK COUNTY PLAZA, SUITE 50, BALSAM LAKE, WI 54810

2

04/01/2018 03/31/2019RUSK COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 311 E MINER ST, LADYSMITH, WI 548482

04/01/2018 03/31/2019WASHBURN COUNTY DEPT OF HEALTH AND HUMAN SERVICES, 110 4TH AVENUE, SHELL LAKE, WI 54871

2

06/26/2018 Page 16 of 172

Substance Abuse Program Directory By County, City, and Provider Name

CLARKNEILLSVILLE

1201CLARK COUNTY COMMUNITY SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/01/1984

(715) 743-5209

(715) [email protected] VOIGT

County: ClarkNEILLSVILLE, WI 54456517 COURT STREET RM 503

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019CLARK COUNTY REHABILITATION AND LIVING CENTER, W4266 STATE HWY 29, OWEN, WI 544602

01/01/2018 12/31/2019GRANTON SCHOOL DISTRICT, 217 N. MAIN STREET, GRANTON, WI 544363

01/01/2018 12/31/2019GREENWOOD ELEMENTARY, 700 EAST DIVISION STREET, GREENWOOD, WI 544373

01/01/2018 12/31/2019GREENWOOD MIDDLE/HIGH SCHOOL, 306 WEST CENTRAL AVENUE, GREENWOOD, WI 544373

01/01/2018 12/31/2019LOYAL SCHOOL DISTRICT, 514 WEST CENTRAL STREET, LOYAL, WI 544463

01/01/2018 12/31/2019NEILLSVILLE ELEMENTARY SCHOOL, 504 EAST 5TH STREET, NEILLSVILLE, WI 544563

01/01/2018 12/31/2019NEILLSVILLE MIDDLE/HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI 544563

01/01/2018 12/31/2019OWEN-WITHEE SHOOL DISTRICT, 832 WEST 3RD STREET, OWEN, WI 544603

01/01/2018 12/31/2019SCHOOL DISTRICT OF THORP, 605 SOUTH CLARK STREET, THORP, WI 547713

3093CLARK COUNTY COMMUNITY SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201609/01/2015

(715) 743-5209

(715) [email protected] VOIGT

County: ClarkNEILLSVILLE, WI 54456517 COURT STREET, ROOM 503

CCS Affiliaton: 09/01/2015Begin: End: Lead:CCS of Clark and Trempealeau Counties

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

1202CLARK COUNTY COMMUNITY SUPPORT PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201704/01/1991

(715) 743-5209

(715) [email protected] GIRARD

County: ClarkNEILLSVILLE, WI 54456517 COURT ST, ROOM 503

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 12/01/2017 11/30/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 17 of 172

Substance Abuse Program Directory By County, City, and Provider Name

COLUMBIAPORTAGE

1066ASPEN FAMILY COUNSELING

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/01/2015

(608) 742-3641

(608) [email protected] ERATH

County: ColumbiaPORTAGE, WI 539012639 NEW PINERY ROAD, #1

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2017 12/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2017 12/31/2018ASPEN FAMILY COUNSELING, 120 3RD STREET, BARABOO, WI 539131

Setting Begin/End DatesNon-Certified School Setting(s)01/01/2017 12/31/2018BARABOO HIGH SCHOOL, 120 DRAPER ST, BARABOO, WI 53913

01/01/2017 12/31/2018CAMBRIA FRIELAND SCHOOL, 410 E EDGEWATER ST, CAMBRIA, WI 53923

01/01/2017 12/31/2018PARDEEVILLE MIDDLE AND HIGH SCHOOL, 120 OAK ST, PARDEEVILLE, WI 53954

01/01/2017 12/31/2018POYNETTE SCHOOLS, 108 N CLEVELAND ST, POYNETTE, WI 53955

01/01/2017 12/31/2018WESTFIELD ELEMENTARY, 329 HAWK LANE, WESTFIELD, WI 53964

2898COLUMBIA COUNTY COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2010

(608) 742-9700

(608) [email protected] WOODARD

County: ColumbiaPORTAGE, WI 539012652 MURPHY ROAD

CCS Affiliaton: 07/01/2014Begin: End: Lead:Wisconsin River CCS Collaboration

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

2149COMMUNITY SERVICES ASSOCIATES DBA PAUQUETTE CTR FOR PSYCHOLOGICAL SVCS

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201810/08/1999

(608) 742-4087

(608) [email protected] SKIBICKY

County: ColumbiaPORTAGE, WI 539012901 HUNTERS TRAIL

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 1002 LINCOLN AVE, BARABOO, WI 539132

07/01/2018 06/30/2020COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 1343 PARK AVE, COLUMBUS, WI 539252

07/01/2018 06/30/2020COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 23295 US HIGHWAY 14 WEST, RICHLAND CENTER, WI 53581

2

07/01/2018 06/30/2020COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 50 PRAIRIE AVE, PRAIRIE DU SAC, WI 535782

07/01/2018 06/30/2020COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 710 NORTH WEBB AVE STE 400, REEDSBURG, WI 53959

2

06/26/2018 Page 18 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3159JOURNEY MENTAL HEALTH CENTER CSP - COLUMBIA CO

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201710/31/2016

(608) 280-2707

(608) 280-3166dawn.anderson-mueller@journeymhDAWN ANDERSON-MUELLER

County: ColumbiaPORTAGE, WI 53901322 DE WITT STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 11/01/2017 10/31/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

2915TRANSITIONS BEHAVIORAL HEALTH LLC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/01/2010

(608) 745-1757

(608) [email protected] BECKETT

County: ColumbiaPORTAGE, WI 53901317 DE WITT ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 19 of 172

Substance Abuse Program Directory By County, City, and Provider Name

CRAWFORDPRAIRIE DU CHIEN

2376CRAWFORD COUNTY COMMUNITY SUPPORT PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201805/01/2002

(608) 326-4395

(608) [email protected] MCWILLIAMS

County: CrawfordPRAIRIE DU CHIEN, WI 53821225 N BEAUMONT ROAD #326

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

1369MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER INC. PRAIRIE DU CHIEN

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201701/01/1987

(608) 326-8638

(608) [email protected] ANTHONY

County: CrawfordPRAIRIE DU CHIEN, WI 53821800 E BLACKHAWK AVENUE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 04/01/2017 03/31/2019

CSAS-PREVENTION DHS 75.04 04/01/2017 01/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 20 of 172

Substance Abuse Program Directory By County, City, and Provider Name

DANEMADISON

3034ARC - MATERNAL AND INFANT PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201708/01/2014

(608) 223-9107

(608) [email protected] VAN TOL

County: DaneMADISON, WI 537164202 MONONA DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 08/01/2017 07/31/2018

Services

NO BRANCH LOCATIONS

1053ARC COMMUNITY SERVICES INC MADISON

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/1995

(608) 283-6374

(608) [email protected] FABICK

County: DaneMADISON, WI 537131409 EMIL STREET #100

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2017 02/28/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

3120ARC DAYTON

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201804/01/201704/01/2016

(608) 241-8073

(608) [email protected] RYAN

County: DaneMADISON, WI 537042009 E DAYTON ST

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 04/01/2017 03/31/2018

Services

NO BRANCH LOCATIONS

1054ARC HOUSE

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201712/01/1990

(608) 283-6432

(608) [email protected] MILLER

County: DaneMADISON, WI 53703202 N. PATERSON STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

1076ATTIC CORRECTIONAL SERVICES, INC. ACS CLINICAL SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201703/25/2010

(608) 255-4005

(608) [email protected] WALKER

County: DaneMADISON, WI 537131709 S PARK STREET SUITE 1

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 21 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2407CONNECTIONS COUNSELING

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201701/01/2003

(608) 233-2101

(608) 233-2100shelly.dutch@connectionscounselinSHELLY DUTCH

County: DaneMADISON, WI 537055005 UNIVERSITY AVE SUITE #100

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2017 03/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2017 03/31/2019CONNECTIONS COUNSELING, 660 WEST WASHINGTON AVE SUITE 308, MADISON, WI 537032

3036DANE COUNTY HUMAN SERVICES CCS

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/01/2015

(608) 242-6531

(608) [email protected] MEISTER

County: DaneMADISON, WI 537041202 NORTHPORT DRIVE

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

1327FAMILY SERVICE MADISON, INC.

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201704/01/1977

(608) 252-1333

(608) [email protected] SCHOFF

County: DaneMADISON, WI 53713128 E. OLIN AVENUE, #100

Service Begin/End DatesAdm Code

CSAS-PREVENTION DHS 75.04 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

1774HOPE HAVEN-REBOS UNITED, INC - CHRIS FARLEY HOUSE

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201610/01/1993

(608) 255-0340

(608) [email protected] COLLINS

County: DaneMADISON, WI 53715810 W. OLIN AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 12/01/2016 11/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 22 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2986JESSIE CRAWFORD RECOVERY CENTER, INC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201611/02/2012

(608) 467-9135

(608) [email protected] CRAWFORD

County: DaneMADISON, WI 537042101 N SHERMAN AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 11/01/2016 10/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

1596JOURNEY MENTAL HEALTH CENTER

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202003/01/201810/01/1975

(608) 280-2707

(608) [email protected] LETTMAN SHUE

County: DaneMADISON, WI 5371149 KESSEL COURT

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/28/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2018 02/28/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/28/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2018 02/28/2020

Services

NO BRANCH LOCATIONS

1598JOURNEY MENTAL HEALTH CENTER - FORWARD SOLUTIONS CSP

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201609/01/1990

(608) 280-3185

(608) [email protected] ALBERTSON

County: DaneMADISON, WI 537141320 MENDOTA ST SUITE 120

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 06/01/2018 10/31/2018

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

1599JOURNEY MENTAL HEALTH CENTER GATEWAY COMMUNITY SUPPORT PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201906/26/201709/01/1990

(608) 280-3160

(608) [email protected] KLEIN

County: DaneMADISON, WI 53713208 E OLIN AVE STE 205

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/26/2017 01/31/2019

Services

NO BRANCH LOCATIONS

1593JOURNEY MENTAL HEALTH CENTER-COMMUNITY TREATMENT ALTERNATIVES CSP

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201802/01/1992

(608) 280-2775

(608) [email protected] DELAP

County: DaneMADISON, WI 537042000 FORDEM AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 23 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1013MERITER HOSPITAL BEHAVIORAL SERVICES PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201601/01/1984

(608) 417-5334

(608) [email protected] JANTY

County: DaneMADISON, WI 53715202 S. PARK STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 12/01/2016 11/30/2018

MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

1617MERITER NEWSTART OUTPATIENT CLINIC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201601/01/1988

(608) 271-3457

(608) [email protected] BORMANN

County: DaneMADISON, WI 537191015 GAMMON LANE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

1549MILWAUKEE HEALTH SERVICES SYSTEM, LLC DBA MADISON EAST COMPREHENSIVE TREATMENT C

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201601/01/1994

(608) 242-1166

(608) [email protected] RAGLAND

County: DaneMADISON, WI 537185109 WORLD DAIRY DRIVE

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

1674NORTH BAY LODGE

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201602/01/1984

(608) 242-0021

(608) [email protected] HENDRICKS

County: DaneMADISON, WI 537043602 MEMORIAL DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 12/01/2016 11/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

1750PROGRAM FOR ASSERTIVE COMMUNITY TREATMENT (PACT)

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201709/01/1989

(608) 266-3638

(608) [email protected] LANE FREY

County: DaneMADISON, WI 53703600 WILLIAMSON STREET, #A-B

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 24 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3165PSYCHOLOGICAL ADDICTION SERVICES LLC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/05/201812/05/201711/27/2017

(608) 416-5777

(608) [email protected] ZUKOWSKI

County: DaneMADISON, WI 537043113 E WASHINGTON AVE

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 12/05/2017 12/05/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/05/2017 12/05/2018

Services

NO BRANCH LOCATIONS

2595QUALITY ADDICTION MANAGEMENT, INC DBA MADISON WEST COMPREHENSIVE TREATMENT CTR

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201607/11/2005

(608) 250-2516

(608) [email protected] OKETCH

County: DaneMADISON, WI 53713151 E BADGER ROAD #A

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

2920ROGERS MEMORIAL HOSPITAL - MADISON PARTIAL HOSPITALIZATION PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201710/13/2010

(608) 238-4412

(608) [email protected] SCHULTZ

County: DaneMADISON, WI 53711406 SCIENCE DRIVE RM #110 & 200

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 11/01/2017 10/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 11/01/2017 10/31/2019

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

1904TELLURIAN, INC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201704/01/1985

(608) 223-3304

(608) [email protected] CROOKS

County: DaneMADISON, WI 537132914 INDUSTRIAL DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 11/01/2017 10/31/2019

CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 25 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1147THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION, AND TRAINING INC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/01/1982

(608) 274-8783

(608) [email protected] RANDALL

County: DaneMADISON, WI 537185310 WALL STREET, #500

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020THE CTR CHRISTIAN CNSLNG CONS, 208 E MILWAUKEE AVENUE, FORT ATKINSON, WI 535381

1919THE PSYCHOLOGY CLINIC, INC.

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201610/01/1991

(608) 238-1929

(608) [email protected] BLACK, PHD

County: DaneMADISON, WI 53705310 N MIDVALE BOULEVARD #202

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2016 10/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2016 10/31/2018THE PSYCHOLOGY CLINIC, INC - WI DELLS, 1000 HWY 13, WISCONSIN DELLS, WI 539651

11/01/2016 10/31/2018THE PSYCHOLOGY CLINIC, INC - BARABOO, 701 ASH STREET, BARABOO, WI 539132

11/01/2016 10/31/2018THE PSYCHOLOGY CLINIC, INC - PRAIRIE DU SAC, 1190 PRAIRIE STREET, PRAIRIE DU SAC, WI 53578

2

11/01/2016 10/31/2018SAUK PRAIRIE HIGH SCHOOL, 105 NINTH STREET, PRAIRIE DU SAC, WI 535783

1940UNIVERSITY OF WI HOSPITALS & CLINICS

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201811/01/1990

(608) 263-9045

(608) [email protected] GREEN

County: DaneMADISON, WI 53713122 E. OLIN AVENUE, #275

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

1374UW HEALTH BEHAVIORAL HEALTH & RECOVERY

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201601/01/1992

(608) 287-5992

(608) [email protected] WAUPOOSE

County: DaneMADISON, WI 537151102 SOUTH PARK ST SUITE #400

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 26 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MONONA

1901TELLURIAN OUTPATIENT CLINIC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201704/27/2011

(608) 222-5904

(608) [email protected] CROOKS

County: DaneMONONA, WI 53716300 FEMRITE DR - 2ND FLOOR

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 08/01/2017 07/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

1900TELLURIAN, INC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/01/1993

(608) 663-6694

(608) [email protected] CROOKS

County: DaneMONONA, WI 53716300 FEMRITE DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

STOUGHTON

2675OCEANHAWK COUNSELING ALTERNATIVES, LLC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/17/2006

(877) 674-2177

(608) [email protected] DAUTE

County: DaneSTOUGHTON, WI 53589135 W MAIN STREET, #207A

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

1884STOUGHTON HOSPITAL

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201709/01/1997

(608) 873-2339

(608) [email protected] KLEINBROOK

County: DaneSTOUGHTON, WI 53589900 RIDGE STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2017 08/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 27 of 172

Substance Abuse Program Directory By County, City, and Provider Name

SUN PRAIRIE

1742PRAIRIE COUNSELING SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201607/01/1978

(608) 825-4933

(608) [email protected] HUBBARD

County: DaneSUN PRAIRIE, WI 535901460 W. MAIN STREET #6

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2016 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 07/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 28 of 172

Substance Abuse Program Directory By County, City, and Provider Name

DODGEBEAVER DAM

1018AFFILIATED COUNSELING CENTER, LLC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201711/01/1989

(920) 887-3977

(920) [email protected] SCHWEFEL-MASSIE

County: DodgeBEAVER DAM, WI 53916108 N LINCOLN AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2017 09/30/2019AFFILIATED COUNSELING CENTER, LLC, 17 FOREST AVENUE, FOND DU LAC, WI 549351

1753AGNESIAN HEALTHCARE D B A PSYCHIATRIC ASSOCIATES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201808/01/201610/01/1984

(920) 885-2788

(920) [email protected] KARTHEISER

County: DodgeBEAVER DAM, WI 53916200 FRONT STREET #3D

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2016 06/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 06/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2016 06/30/2018WAYLAND ACACDEMY COUNSELING SERVICES - SCHOEN, 101 NORTH UNIVERSITY AVE, BEAVER

DAM, WI 539163

3106CHURCH HEALTH SERVICES, INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201711/17/2015

(920) 887-2322

(920) [email protected] KEMPFER

County: DodgeBEAVER DAM, WI 53916115 N CENTER STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2017 10/31/2019CHURCH HEALTH SERVICES, 15 S. WALNUT STREET, MAYVILLE, WI 530501

Setting Begin/End DatesNon-Certified School Setting(s)11/01/2017 10/31/2019BEAVER DAM HIGH SCHOOL, 500 GOULD ST, BEAVER DAM, WI 53916

11/01/2017 10/31/2019BEAVER DAM MIDDLE SCHOOL, 108 FOURTH STREET, BEAVER DAM, WI 53916

11/01/2017 10/31/2019BEAVER DAM USD ADMIN BLDG, 705 MCKINLEY STREET, BEAVER DAM, WI 53916

11/01/2017 10/31/2019DON SMITH LEARNING ACADEMY, 400 E BURNETT STREET, BEAVER DAM, WI 53916

11/01/2017 10/31/2019JEFFERSON ELEMENTARY, 301 BROOK ST, BEAVER DAM, WI 53916

11/01/2017 10/31/2019LINCOLN ELEMENTARY, 210 GOULD ST, BEAVER DAM, WI 53916

11/01/2017 10/31/2019PRAIRIE VIEW ELEMTARY, 510 N CRYSTAL LAKE ROAD, BEAVER DAM, WI 53916

11/01/2017 10/31/2019SO BEAVER DAM ELEMENTARY, W9787 COUNTY ROAD D, BEAVER DAM, WI 53916

11/01/2017 10/31/2019WASHINGTON ELEMENTARY, 600 GROVE STREET, BEAVER DAM, WI 53916

11/01/2017 10/31/2019WILSON ELEMENTARY, 405 W 3RD STREET, BEAVER DAM, WI 53916

06/26/2018 Page 29 of 172

Substance Abuse Program Directory By County, City, and Provider Name

JUNEAU

2764DODGE COUNTY HUMAN SERVICES & HEALTH DEPT COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201712/11/2007

(920) 386-3812

(920) [email protected] SCHULTZ

County: DodgeJUNEAU, WI 53039199 COUNTY RD DF

CCS Affiliaton: 01/01/2015Begin: End: Lead:Lakeshore Recovery Collaborative

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

1282DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201710/01/1975

(920) 386-3812

(920) [email protected] SCHULTZ

County: DodgeJUNEAU, WI 53039199 COUNTY RD DF

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2017 02/28/2019

CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2017 02/28/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2017 02/28/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2017 02/28/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2017 02/28/2019LOMIRA SCHOOL, 1030 4TH ST., LOMIRA, WI 530483

03/01/2017 02/28/2019MAYVILLE HIGH SCHOOL, 500 N. CLARK ST., MAYVILLE, WI 530503

03/01/2017 02/28/2019MAYVILLE MIDDLE SCHOOL, 445 N. HENNINGER ST. RM 3013, MAYVILLE, WI 530503

03/01/2017 02/28/2019ROCK RIVER INTERMEDIATE SCHOOL, 451 E. SPRING ST. RM 153 B, WAUPUN, WI 539633

03/01/2017 02/28/2019VAN BRUNT ELEMENTARY, 611 MILL ST. RM 447, HORICON, WI 530323

2100DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201701/01/1999

(920) 386-3812

(920) [email protected] SCHULTZ

County: DodgeJUNEAU, WI 53039199 COUNTY ROAD DF

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 30 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WATERTOWN

1278WATERTOWN PHYSICIAN PRACTICES, LLC DBA WRMC DIRECTIONS COUNSELING CENTER

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201811/01/1981

(920) 262-4813

(920) [email protected] NOVOTNY

County: DodgeWATERTOWN, WI 53098123 HOSPITAL DRIVE SUITE 110

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019WRMC CENTER FOR WOMEN'S HEALTH, 128 HOSPITAL DRIVE, WATERTOWN, WI 530981

01/01/2018 12/31/2019WRMC DOCTOR'S COURT CLINIC, 1507 DOCTOR'S COURT, WATERTOWN, WI 530941

01/01/2018 12/31/2019WRMC JOHNSON CREEK CLINIC, 540J VILLAGE WALK LANE, JOHNSON CREEK, WI 530381

01/01/2018 12/31/2019WRMC JUNEAU CLINIC, 334 S WESTERN AVENUE, JUNEAU, WI 530391

01/01/2018 12/31/2019WRMC LAKE MILLS CLINIC, 1025 MULBERRY STREET, LAKE MILLS, WI 535511

06/26/2018 Page 31 of 172

Substance Abuse Program Directory By County, City, and Provider Name

DOORSTURGEON BAY

1250COUNSELING ASSOCIATES OF DOOR COUNTY LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201611/16/1993

(920) 743-1591

(920) [email protected] G NICK

County: DoorSTURGEON BAY, WI 54235620 N 12TH AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2016 11/30/2018COUNSELING ASSOCIATES OF DOOR COUNTY -GB, 330 SOUTH BROADWAY, GREEN BAY, WI 543031

1283DOOR COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201601/01/1978

(920) 746-2439

(920) [email protected] MCFARLANE

County: DoorSTURGEON BAY, WI 54235421 NEBRASKA STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2016 09/30/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/14/2017 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/14/2017 09/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2016 09/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 03/14/2017 09/30/2018

Services

NO BRANCH LOCATIONS

2159DOOR COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201710/01/1999

(920) 746-2439

(920) [email protected] FLORES

County: DoorSTURGEON BAY, WI 54235421 NEBRASKA STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

3057DOOR COUNTY DEPT OF HUMAN SERVICES - CCS

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201612/01/2014

(920) 746-2439

(920) [email protected] MCFARLANE

County: DoorSTURGEON BAY, WI 54235421 NEBRASKA STREET

CCS Affiliaton: 12/01/2014Begin: End: Lead:Lakeshore Recovery Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 32 of 172

Substance Abuse Program Directory By County, City, and Provider Name

DOUGLASSUPERIOR

2847DOUGLAS COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/06/2009

(715) 395-1265

(715) [email protected] LONGSDORF

County: DouglasSUPERIOR, WI 548801316 N 14TH STREET SUITE 400

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

2312HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201812/01/1982

(715) 392-6055

(715) [email protected] ENGLESON

County: DouglasSUPERIOR, WI 548801500 N 34TH ST #100

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3195LAKE SUPERIOR COMMUNITY HEALTH CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/05/201802/05/2018

(218) 722-6939

(218) [email protected] PATTERSON

County: DouglasSUPERIOR, WI 548803600 TOWER AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/05/2018 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/05/2018 01/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier02/05/2018 01/31/2019LSCHC OP MH/AODA OFFICE, 1500 N 34TH STREET #200, SUPERIOR, WI 548802

1926RIDGEWOOD RECOVERY, INC. DBA THE SUPERIOR TREATMENT CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201702/01/1997

(715) 392-8041

(715) [email protected] FETSCH

County: DouglasSUPERIOR, WI 548801810 BELKNAP STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 33 of 172

Substance Abuse Program Directory By County, City, and Provider Name

DUNNMENOMONIE

1050ARBOR PLACE, INC.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201712/01/1993

(715) 235-4535

(715) [email protected] GAMEZ

County: DunnMENOMONIE, WI 547514076 KOTHLOW AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/01/2017 09/30/2019

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 10/01/2017 09/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 09/30/2019

CSAS-PREVENTION DHS 75.04 10/01/2017 09/30/2019

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 10/01/2017 09/30/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

2055DUNN COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201706/01/1998

(715) 232-5987

(715) [email protected] WINGER

County: DunnMENOMONIE, WI 547513001 US HWY 12 EAST, SUITE 160

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2017 05/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 34 of 172

Substance Abuse Program Directory By County, City, and Provider Name

EAU CLAIREALTOONA

1348FIRST THINGS FIRST COUNSELING & CONSULTING

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201709/01/1990

(715) 832-5007

(715) [email protected] DRAKE

County: Eau ClaireALTOONA, WI 547202519 N HILLCREST PKWY STE 103

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2018

Services

NO BRANCH LOCATIONS

EAU CLAIRE

1020AFFINITY HOUSE

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202003/01/201803/01/1992

(715) 833-1505

(715) [email protected] KUSTER

County: Eau ClaireEAU CLAIRE, WI 547033042 KILBOURNE AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 03/01/2018 02/28/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2018 02/28/2020

Services

NO BRANCH LOCATIONS

1119CAILLIER CLINIC, LTD.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201601/01/1983

(715) 836-0065

(715) [email protected] CAILLIER

County: Eau ClaireEAU CLAIRE, WI 547012620 STEIN BLVD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2016 11/30/2018CAILLIER CLINIC LTD., 700 WOLSKE BAY RD, STE 210, MENOMONIE, WI 547511

12/01/2016 11/30/2018CAILLIER CLINIC, LTD, 138 N. MAIN ST SUITE 206, RICE LAKE, WI 548682

1292EAU CLAIRE ACADEMY, DIVISION OF CLINICARE CORPORATION

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201702/01/1994

(715) 834-9954

(715) [email protected] MATTER

County: Eau ClaireEAU CLAIRE, WI 54703550 N. DEWEY STREET

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 09/01/2017 08/31/2019

CSAS-TRANSITIONAL RESIDENTIAL WITH TELEHEALTH HFS 75.14 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 35 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3112EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES - CCS PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201804/01/2016

(715) 831-5784

(715) [email protected] STEIN

County: Eau ClaireEAU CLAIRE, WI 54703721 OXFORD AVENUE

CCS Affiliaton: 04/01/2016Begin: End: Lead:Eau Claire and St. Croix CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2018 03/31/2019

Services

NO BRANCH LOCATIONS

1293EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202003/01/201801/01/1990

(715) 831-5783

(715) [email protected] HON

County: Eau ClaireEAU CLAIRE, WI 54703721 OXFORD AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2018 02/28/2020

Services

NO BRANCH LOCATIONS

2537EAU CLAIRE METRO TREATMENT CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201708/16/2004

(715) 834-1218

(715) [email protected] BAKER

County: Eau ClaireEAU CLAIRE, WI 547032000 OXFORD AVE NORTH BLDG 2

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 06/01/2017 05/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2017 05/31/2020

Services

NO BRANCH LOCATIONS

3083GATEWAY COUNSELING, LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201802/01/201602/09/2015

(715) [email protected] BRAHAN

County: Eau ClaireEAU CLAIRE, WI 547013459 LONDON ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2016 01/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 36 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2993GREAT LAKES BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201703/01/2013

(715) 834-4427

(715) [email protected] MATTER

County: Eau ClaireEAU CLAIRE, WI 54703550 NORTH DEWEY STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2017 08/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2019MILWAUKEE ACADEMY, 9501 WATERTOWN PLANK ROAD, WAUWATOSA, WI 532131

1529LUTHERAN SOCIAL SERVICES-FAHRMAN CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201811/01/1986

(715) 830-4098

(715) [email protected] SWEENEY

County: Eau ClaireEAU CLAIRE, WI 547013136 CRAIG ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 07/01/2018 06/30/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

1511MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201606/01/1981

(715) 838-3649

(715) [email protected] PHILLIPS

County: Eau ClaireEAU CLAIRE, WI 547011221 WHIPPLE STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 12/01/2016 11/30/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 04/25/2017 11/30/2018

MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

1512MAYO CLINIC HEALTH SYSTEM EAU CLAIRE

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201710/01/1981

(715) 838-3032

(715) [email protected] MING

County: Eau ClaireEAU CLAIRE, WI 547021221 WHIPPLE STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 01/01/2017 12/31/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/27/2018 12/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2017 12/31/2018MAYO CLINIC HEALTH SYSTEMS - CHIPPEWA FALLS OFFICE, 611 1ST AVENUE, CHIPPEWA FALLS,

WI 547291

01/01/2017 12/31/2018MAYO CLINIC HEALTH SYSTEM NORTHLAND, 331 S MAIN STREET, RICE LAKE, WI 548682

06/26/2018 Page 37 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3114NORTH WEST WISCONSIN COMPREHENSIVE TREATMENT CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201903/01/201702/29/2016

(760) 930-8923

(855) [email protected] JOHNSON

County: Eau ClaireEAU CLAIRE, WI 547013440 OAKWOOD HILLS PKWY

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2017 10/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

2947SACRED HEART BEHAVIORAL HEALTH CLINIC DBA PREVEA HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201808/29/201610/31/2011

(715) 717-5898

(715) [email protected] SIMONSON

County: Eau ClaireEAU CLAIRE, WI 547012119 HEIGHTS DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/29/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/29/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/29/2016 12/31/2016

Services

NO BRANCH LOCATIONS

1408SYNERGY GROUP OF EAU CLAIRE, SC DBA VANTAGE POINT CLINIC & ASSESSMENT CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201608/01/1990

(715) 834-3174

(715) [email protected] BJERKE

County: Eau ClaireEAU CLAIRE, WI 547012005 HIGHLAND AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 1443 B EAST DIVISION AVE, BARRON,

WI 548122

09/01/2016 08/31/2018SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 420 S BARSTOW STREET, #3, EAU CLAIRE, WI 54701

2

1936TRINITEAM, INC.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201810/01/201703/01/1989

(715) 836-8104

(715) [email protected] PEITZMAN

County: Eau ClaireEAU CLAIRE, WI 54701202 GRAHAM AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 03/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2017 03/31/2018BUFFALO CO COURTHOUSE- DHS TRINITEAM, 407 SOUTH SECOND ST, ALMA, WI 546101

06/26/2018 Page 38 of 172

Substance Abuse Program Directory By County, City, and Provider Name

FOND DU LACEDEN

3144MAHALA'S HOPE

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201709/12/2016

(920) 477-3777

(920) [email protected] HARDIE

County: Fond Du LacEDEN, WI 53019N4590 HWY 45

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

FOND DU LAC

3121ARC FOND DU LAC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201706/01/2016

(920) 907-0681

(920) [email protected] RHOADS

County: Fond Du LacFOND DU LAC, WI 5493527 EAST 3RD ST #208

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 06/01/2017 05/31/2019

Services

NO BRANCH LOCATIONS

1085BEACON HOUSE

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201805/28/1993

(920) 923-3240

(920) [email protected] GERLACH

County: Fond Du LacFOND DU LAC, WI 54936166 SOUTH PARK AVENUE

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

1108BLANDINE HOUSE, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/08/1991

(920) 922-9184

(920) [email protected] MIER SR.

County: Fond Du LacFOND DU LAC, WI 5493525 N. PARK AVENUE

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 39 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2680FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS CCS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201901/01/201807/18/2006

(920) 929-3129

(920) 929-7123heather [email protected] FOUST

County: Fond Du LacFOND DU LAC, WI 54935459 E FIRST STREET

CCS Affiliaton: 01/01/2018Begin: End: Lead:Northeastern Regional CCS Consortium V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2018 07/31/2019

Services

NO BRANCH LOCATIONS

1350FOND DU LAC COUNTY DEPT OF COMMUNITY PROGRAMS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201807/01/1978

(920) 929-3129

(920) [email protected] VANEVENHOVEN

County: Fond Du LacFOND DU LAC, WI 54935459 E FIRST STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2018 02/29/2020

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

CSAS-PREVENTION DHS 75.04 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2018 02/29/2020

MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

3075PREMIER CARE OF WISCONSIN LLC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201605/05/2015

(800) 377-9518

(920) [email protected] ROGERS

County: Fond Du LacFOND DU LAC, WI 5493523 WEST SCOTT ST

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 05/01/2016 04/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2016 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 40 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1847ST. AGNES HOSPITAL BEHAVIORAL HEALTH SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201805/01/1980

(920) 926-8933

(920) [email protected] KARTHEISER

County: Fond Du LacFOND DU LAC, WI 54935430 EAST DIVISION STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2018 12/31/2019

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2018 12/31/2019

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 01/01/2018 12/31/2019

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 01/01/2018 12/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2018 12/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019ST AGNES HOSPITAL BEHAVIORAL HEALTH SVS, 608 W BROWN ST, WAUPUN, WI 539631

01/01/2018 12/31/2019AGNESIAN AT MARR, 21 S MARR STREET, FOND DU LAC, WI 549352

01/01/2018 12/31/2019ST AGNES HOSPITAL BEHAVIORAL HEALTH, 845 PARKSIDE, RIPON, WI 549712

01/01/2018 12/31/2019WAUPUN MEM HOSP BEHAVIORAL HEALTH, 620 W BROWN ST, WAUPUN, WI 539632

06/26/2018 Page 41 of 172

Substance Abuse Program Directory By County, City, and Provider Name

FORESTCRANDON

1351FOREST COUNTY POTAWATOMI BEHAVIORAL HEALTH DEPARTMENT

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201704/01/1994

(715) 478-4493

(715) [email protected] NICKEY

County: ForestCRANDON, WI 545208201 MISH KO SWEN DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 04/01/2018 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2017 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 42 of 172

Substance Abuse Program Directory By County, City, and Provider Name

GRANTLANCASTER

1943UNIFIED COMMUNITY SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201710/01/1975

(608) 723-4417

(608) [email protected] KNAPP

County: GrantLANCASTER, WI 53813200 W ALONA LANE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2017 06/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

CSAS-PREVENTION DHS 75.04 07/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2017 06/30/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

1941UNIFIED COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201607/01/1994

(608) 723-4417

(608) [email protected] KNAPP

County: GrantLANCASTER, WI 53813200 W. ALONA LANE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2016 09/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2016 09/30/2018UNIFIED COMMUNITY SERVICES - CSP, 1122 PROFESSIONAL DRIVE, DODGEVILLE, WI 535331

06/26/2018 Page 43 of 172

Substance Abuse Program Directory By County, City, and Provider Name

GREENMONROE

1388GREEN COUNTY HUMAN SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201810/01/1975

(608) 328-9480

(608) [email protected] HOLCOMB

County: GreenMONROE, WI 53566N3152 STATE ROAD 81

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 01/01/2018 12/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

CSAS-PREVENTION DHS 75.04 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019GREEN COUNTY ADULT DRUG COURT, 2841 6TH STREET, MONROE, WI 535662

2328GREEN COUNTY HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/01/2000

(608) 328-9480

(608) [email protected] HOLCOMB

County: GreenMONROE, WI 53566N 3152 STATE ROAD 81

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

3085GREEN/LAFAYETTE REGIONAL COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201706/01/2015

(608) 328-9480

(608) [email protected] FARREY

County: GreenMONROE, WI 53566N3152 STATE RD 81

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 06/01/2017 05/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2017 05/31/2019GREEN/LAFAYETTE REGIONAL CCS AT LAFAYETTE CTY HS, 15701 COUNTY ROAD K, DARLINGTON,

WI 535301

06/26/2018 Page 44 of 172

Substance Abuse Program Directory By County, City, and Provider Name

GREEN LAKEGREEN LAKE

1389GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201604/01/1977

(920) 294-4139

(920) [email protected] JEROME

County: Green LakeGREEN LAKE, WI 54941571 COUNTY ROAD A

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 11/01/2016 10/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

CSAS-PREVENTION DHS 75.04 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2016 10/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2016 10/31/2018

Services

Setting Begin/End DatesNon-Certified School Setting(s)11/01/2016 10/31/2018BERLIN MIDDLE SCHOOL, 242 MEMORIAL DRIVE, BERLIN, WI 54923

2265GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201711/01/2000

(920) 294-4139

(920) [email protected] JEROME

County: Green LakeGREEN LAKE, WI 54941571 COUNTY ROAD A

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

2599GREEN LAKE COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201708/22/2005

(920) 294-4139

(920) [email protected] JEROME

County: Green LakeGREEN LAKE, WI 54941571 COUNTY ROAD A

CCS Affiliaton: 09/01/2014 12/31/2015Begin: End: Lead:Central Wisconsin Health Partnership

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 45 of 172

Substance Abuse Program Directory By County, City, and Provider Name

IOWADODGEVILLE

1942UNIFIED COMMUNITY SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201710/01/1975

(608) 935-3174

(608) [email protected] KNAPP

County: IowaDODGEVILLE, WI 535331122 PROFESSIONAL DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 46 of 172

Substance Abuse Program Directory By County, City, and Provider Name

IRONHURLEY

2347IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/2002

(715) 561-2128

(715) [email protected] BUCKNELL

County: IronHURLEY, WI 54534300 TACONITE STREET, #201

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2017 02/28/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2017 02/28/2019HURLEY SCHOOL DISTRICT, 5503 W RANGE VIEW DR, HURLEY, WI 545343

2745IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES COMM SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/2007

(715) 561-2128

(715) [email protected] BUCKNELL

County: IronHURLEY, WI 54534300 TACONITE STREET, #201

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 03/01/2017 02/28/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 47 of 172

Substance Abuse Program Directory By County, City, and Provider Name

JACKSONBLACK RIVER FALLS

1413HO-CHUNK NATION DEPARTMENT OF HEALTH DIVISION OF BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201605/01/1992

(715) 284-3434

(715) [email protected] SUQUET

County: JacksonBLACK RIVER FALLS, WI 54615W9850 AIRPORT RD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 04/01/2018 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2018 10/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 10/31/2018MADISON BRANCH OFFICE, 4724 TRADE WINDS PARKWAY, MADISON, WI 537181

11/01/2016 10/31/2018NEKOOSA HEALTH OFFICE, 1021 COUNTY HWY G, NEKOOSA, WI 544572

11/01/2016 10/31/2018THREE RIVERS HOUSE, 724 MAIN STREET, LA CROSSE, WI 546012

11/01/2016 10/31/2018TOMAH HEALTH OFFICE, 430 JULIE ST, STE 2, TOMAH, WI 546602

11/01/2016 10/31/2018WELLNESS CENTER HEALTH OFFICE, S2845 WHITE EAGLE ROAD, BARABOO, WI 539132

03/01/2017 10/31/2018WITTENBERG HEALTH OFFICE, W17634 RADKE RD, WITTENBERG, WI 544992

2957JACKSON COUNTY DEPT OF HEALTH & HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201601/01/2012

(715) 284-7713

(715) [email protected] ANDRE

County: JacksonBLACK RIVER FALLS, WI 54615420 HIGHWAY 54 WEST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 48 of 172

Substance Abuse Program Directory By County, City, and Provider Name

JEFFERSONJEFFERSON

1449JEFFERSON COUNTY HUMAN SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201710/01/1975

(920) 674-6113

(920) [email protected] CAULEY

County: JeffersonJEFFERSON, WI 535491541 ANNEX ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2017 05/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2017 05/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 06/01/2017 05/31/2019

Services

NO BRANCH LOCATIONS

2221JEFFERSON COUNTY HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/01/2000

(920) 674-7409

(920) [email protected] THORMAN

County: JeffersonJEFFERSON, WI 535491541 ANNEX ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

2643JEFFERSON COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201702/15/2006

(920) 674-2359

(920) [email protected] CONGDON

County: JeffersonJEFFERSON, WI 535491541 ANNEX ROAD

CCS Affiliaton: 08/01/2014Begin: End: Lead:JRW Tri County Regional CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

WATERTOWN

1326FAMILY RESOURCES ASSOCIATES, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201611/01/1993

(920) 261-8801

(920) [email protected] KUEFFER

County: JeffersonWATERTOWN, WI 530941315 W. MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2016 10/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2016 10/31/2018FAMILY RESOURCES ASSOCIATES INC, 248 S. WISCONSIN DRIVE, JEFFERSON, WI 535492

06/26/2018 Page 49 of 172

Substance Abuse Program Directory By County, City, and Provider Name

JUNEAULYNDON STATION

3173PINE VALLEY INTEGRATED SERVICES LLC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201807/14/2017

(608) 350-1288

(608) [email protected] BRONECKI

County: JuneauLYNDON STATION, WI 53944W1889 KOVAL ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2018 05/31/2020NEW LISBON FAMILY MEDICAL CENTER, 901 BRIDGE ST, NEW LISBON, WI 539501

06/01/2018 05/31/2020MILE BLUFF CLINIC, 1040 DIVISION STREET, MAUSTON, WI 539482

06/01/2018 06/30/2018ADAMS FRIENDSHIP ELEMENTARY SCHOOL, 500 N PIERCE ST, ADAMS, WI 539103

06/01/2018 06/30/2018ADAMS FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 539103

06/01/2018 06/30/2018ADAMS FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 539103

MAUSTON

1453JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/01/1988

(608) 847-9421

(608) [email protected] GEIGER

County: JuneauMAUSTON, WI 53948200 HICKORY STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

3000JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201704/01/2013

(608) 847-9421

(608) [email protected] GEIGER

County: JuneauMAUSTON, WI 53948220 E LA CROSSE STREET RM #23

CCS Affiliaton: 09/01/2014 12/31/2015Begin: End: Lead:Central Wisconsin Health Partnership

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

1452JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201701/01/1989

(608) 847-9576

(608) [email protected] JO ONSAGER

County: JuneauMAUSTON, WI 53948220 E LACROSSE STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 50 of 172

Substance Abuse Program Directory By County, City, and Provider Name

KENOSHABURLINGTON

3185WI AWAKEN INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201811/06/201711/06/2017

(844) 247-2735

(262) [email protected] BISHOP

County: KenoshaBURLINGTON, WI 53105101 EDWARD STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/06/2017 11/30/2018

Services

NO BRANCH LOCATIONS

KENOSHA

2443COMPASSIONATE CARE COUNSELING (A DIV OF COMPETITIVE EDGE EMP ASSURANCE SVS)

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/01/2003

(262) 605-0809

(262) [email protected] M ORLAKIS

County: KenoshaKENOSHA, WI 531403624 - 17TH AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

2200GENESIS BEHAVIORAL SERVICES OPTIONS RESIDENTIAL PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/14/2000

(262) 654-8826

(262) [email protected] SANCHEZ

County: KenoshaKENOSHA, WI 531406755 - 14TH AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 04/01/2018 03/31/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

1024HOPE COUNCIL ON ALCOHOL & OTHER DRUG ABUSE, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201702/15/1990

(262) 658-8210

(262) [email protected] BROWN

County: KenoshaKENOSHA, WI 531405942 - SIXTH AVENUE

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

1440INTERCONNECTIONS, S.C.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201708/01/1981

(262) 654-7818

(262) [email protected] NICHOLS

County: KenoshaKENOSHA, WI 53140920 - 60TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 51 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1014KARE CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201610/10/1987

(262) 653-2080

(262) [email protected] FOSS

County: KenoshaKENOSHA, WI 53140510 - 60TH STREET

Service Begin/End DatesAdm Code

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 08/01/2016 07/31/2018

Services

NO BRANCH LOCATIONS

2589KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201705/01/2005

(262) 697-4655

(262) [email protected] HANKS

County: KenoshaKENOSHA, WI 531438600 SHERIDAN RD #100

CCS Affiliaton: 12/01/2014Begin: End: Lead:Kenosha Racine Regional Consortium (KRRC)

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 05/01/2017 04/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2017 04/30/2019KENOSHA HUMAN DEVELOPMENT SERVICES, INC (KHDS), 5407 8TH AVENUE, KENOSHA, WI 531402

2897KENOSHA HUMAN DEVELOPMENT SERVICES, INC COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/01/2010

(262) 653-2080

(262) [email protected]; [email protected] A HAEN, MS

County: KenoshaKENOSHA, WI 531405407 8TH AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

2613MOORE AND ASSOCIATES/BIRDS OF A FEATHER, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201709/14/2005

(262) 605-1404

(262) [email protected] MOORE

County: KenoshaKENOSHA, WI 531436530 SHERIDAN ROAD, #3

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/01/2017 09/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2017 09/30/2019MOORE & ASSOCIATES, INC, 220 S COUNTY ROAD H, UNIT A, ELKHORN, WI 531211

10/01/2017 09/30/2019MOORE & ASSOCIATES, INC, 1656 WASHINGTON AVE, RACINE, WI 534042

06/26/2018 Page 52 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2028OAKWOOD CLINICAL ASSOCIATES, LTD.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/25/1991

(262) 652-2931

(262) [email protected] ANDERSON

County: KenoshaKENOSHA, WI 531424109 67TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020OAKWOOD CLINICAL ASSOCIATES LTD, 24804 75TH STREET, PADDOCK LAKE, WI 531682

06/26/2018 Page 53 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1749PROFESSIONAL SERVICES GROUP, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201806/01/1983

(262) 652-2408

(262) [email protected] FEATHERSTONE

County: KenoshaKENOSHA, WI 531432108 63RD STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020PROFESSIONAL SERVICES GROUP, 614 N 3RD STREET, WAUSAU, WI 544031

04/01/2018 03/31/2020PROFESSIONAL SERVICES GROUP, 724 ELM STREET, WEST BEND, WI 530951

04/01/2018 03/31/2020PROFESSIONAL SERVICES GROUP, 1126 S 70TH STREET, #112-3, WEST ALLIS, WI 532142

04/01/2018 03/31/2020PROFESSIONAL SERVICES GROUP, 2333 NORTHWESTERN AVE, RACINE, WI 534042

Setting Begin/End DatesNon-Certified School Setting(s)04/01/2018 03/31/2020ADDISON ELEMENTARY, 5050 INDIAN ROAD, HARTFORD, WI 53027

04/01/2018 03/31/2020BADGER MIDDLE SCHOOL, 727 S 6TH AVE, WEST BEND, WI 53095

04/01/2018 03/31/2020CENTRAL MIDDLE SCHOOL, 1100 CEDAR ST, HARTFORD, WI 53027

04/01/2018 03/31/2020COUNTY LINE ELEMENTARY, W159 N9939 BUTTERNUT RD, GERMANTOWN, WI 53022

04/01/2018 03/31/2020DECORAH ELEMENTARY, 1225 SULVAN WAY, WEST BEND, WI 53095

04/01/2018 03/31/2020DREAM CENTER, 1190 WESTERN DR, HARTFORD, WI 53027

04/01/2018 03/31/2020FAIRPARK ELEMENTARY SCHOOL, 519 INDIANA AVE, WEST BEND, WI 53095

04/01/2018 03/31/2020GREAT EXPECTATIONS, 735 MAIN ST, WEST BEND, WI 53095

04/01/2018 03/31/2020HEADSTART, 737 S 3RD AVE, WEST BEND, WI 53095

04/01/2018 03/31/2020I4 LEARNING, 5760 MOWHAWK RD, CAMPBELLSPORT, WI 53010

04/01/2018 03/31/2020KENNEDY MIDDLE SCHOOL, W160 N11836 CRUSADER CT, GERMANTOWN, WI 53022

04/01/2018 03/31/2020KEWAKSUM ELEMENTARY, 1415 BILGO LANE, KEWASKUM, WI 53040

04/01/2018 03/31/2020KEWAKSUM MIDDLE SCHOOL, 1676 REIGLE DR, KEWASKUM, WI 53040

04/01/2018 03/31/2020LAKEWOOD ELEMENTARY SCHOOL, 1218 WILMOT AVE, TWIN LAKES, WI 53181

04/01/2018 03/31/2020LINCOLN ELEMENTARY, 755 RURAL ST, HARTFORD, WI 53027

04/01/2018 03/31/2020MACARTHUR ELEMENTARY SCHOOL, N154 W11942 FOND DU LAC AVE, GERMANTOWN, WI 53022

04/01/2018 03/31/2020MCLANE ELEMENTARY, 833 CHESTNUT ST, WEST BEND, WI 53095

04/01/2018 03/31/2020PATHWAYS CHARTER, 1043 S MAIN ST, WEST BEND, WI 53095

04/01/2018 03/31/2020RANDALL CONSOLIDATED SCHOOL, 37101 87TH ST, BURLINGTON, WI 53105

04/01/2018 03/31/2020RIVERVIEW ELEMENTARY SCHOOL, 300 E PROSSER ST, SILVER LAKE, WI 53170

04/01/2018 03/31/2020ROSSMAN ELEMENTARY, 600 HIGHLAND, HARTFORD, WI 53027

04/01/2018 03/31/2020SILVERBROOK INTERMEDIATE, 120 N SILVERBROOK RD, WEST BEND, WI 53095

04/01/2018 03/31/2020SLINGER MIDDLE SCHOOL, 521 OLYMPIC DR, SLINGER, WI 53086

04/01/2018 03/31/2020WEST BEND EAST HIGH SCHOOL, 1305 E DECORAH RD, WEST BEND, WI 53095

04/01/2018 03/31/2020WILMOT UNION HIGH SCHOOL, 11112 308TH AVE, WILMOT, WI 53192

06/26/2018 Page 54 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1752PSYCHIATRIC AND PSYCHOTHERAPY CLINIC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201806/01/1980

(262) 654-2434

(262) [email protected] DEFAZIO

County: KenoshaKENOSHA, WI 531443601 - 30TH AVENUE, #102

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

2433ROGERS MEMORIAL HOSPITAL CHILD AND ADOLESCENT DAY TREATMENT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/28/2003

(262) 942-7740

(262) [email protected] SCHULTZ

County: KenoshaKENOSHA, WI 531429916 - 75TH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/01/2018 04/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 55 of 172

Substance Abuse Program Directory By County, City, and Provider Name

KEWAUNEEKEWAUNEE

2288KEWAUNEE COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201702/01/1977

(920) 388-7044

(920) [email protected] BORKOVETZ

County: KewauneeKEWAUNEE, WI 54216810 LINCOLN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

1466KEWAUNEE COUNTY DEPT OF HUMAN SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201702/01/1977

(920) 388-7044

(920) [email protected] NORTON

County: KewauneeKEWAUNEE, WI 54216810 LINCOLN STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 02/01/2017 01/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2017 01/31/2019

CSAS-PREVENTION DHS 75.04 02/01/2017 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2017 01/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

2781KEWAUNEE COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201703/11/2008

(920) 388-7044

(920) [email protected] NORTON

County: KewauneeKEWAUNEE, WI 54216810 LINCOLN STREET

CCS Affiliaton: 12/01/2014Begin: End: Lead:Lakeshore Recovery Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 56 of 172

Substance Abuse Program Directory By County, City, and Provider Name

LA CROSSELA CROSSE

3006ACS CLINICAL SERVICES, LLC - LA CROSSE

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201708/01/2013

(608) 784-3384

(608) [email protected] KREGER

County: La CrosseLA CROSSE, WI 546012101 VICTORY STREET

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 08/01/2017 07/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

1240COULEE COUNCIL ON ADDICTIONS, INC.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201611/01/1986

(608) 784-6302

(608) [email protected] HANCOCK

County: La CrosseLA CROSSE, WI 54601921 WEST AVENUE SOUTH

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

CSAS-PREVENTION DHS 75.04 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

2802COUNSELING ASSOCIATES LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/05/2008

(608) 785-0273

(608) [email protected] EINSMAN

County: La CrosseLA CROSSE, WI 54601115 - 5TH AVENUE SOUTH, #301

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2018 05/31/2020COUNSELING ASSOCIATES LLC, 111 MARKET STREET #4A, WINONA, MN 559872

3021DRIFTLESS RECOVERY SERVICES INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201704/14/2014

(608) 519-5909

(608) [email protected] REINHART

County: La CrosseLA CROSSE, WI 54601444 MAIN ST SUITE 301

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 57 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1315FAMILY AND CHILDREN'S CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201702/01/1994

(608) 785-0002

(608) [email protected] SOUTHWORTH

County: La CrosseLA CROSSE, WI 546011707 MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2017 10/31/2019FAMILY AND CHILDREN'S CENTER, 1321 NORTH MAIN ST, VIROQUA, WI 546651

1391GUNDERSEN CLINIC LIMITED BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201912/01/201602/01/1984

(608) 775-6055

(608) [email protected] THOMPSON

County: La CrosseLA CROSSE, WI 546011836 SOUTH AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 12/01/2016 01/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2016 01/31/2019GUNDERSEN CLINIC LTD,, 18606 ERVIN STREET, WHITEHALL, WI 547731

12/01/2016 01/31/2019GUNDERSEN CLINIC, LTD, 226 NORTH 2ND STREET, LA CRESCENT, MN 559471

12/01/2016 01/31/2019GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 110 JEFFERSON STREET, WEST UNION, IA 521751

12/01/2016 01/31/2019GUNDERSON CLINIC LTD, 35791 OSSEO ROAD, INDEPENDENCE, WI 547471

12/01/2016 01/31/2019GUNDERSON CLINIC LTD, 420 SOUTH PETERSON AVE, BLAIR, WI 546161

12/01/2016 01/31/2019RICHLAND MEDICAL CENTER, 301 EAST 2ND STREET, RICHLAND CENTER, WI 535811

12/01/2016 01/31/2019VERNON MEMORIAL HEALTHCARE, 507 SOUTH MAIN ST, VIROQUA, WI 546651

12/01/2016 01/31/2019GUNDERSEN CLINIC LTD, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 538212

12/01/2016 01/31/2019GUNDERSEN CLINIC, LTD, 1830 STATE HWY 9, DECORAH, IA 521012

12/01/2016 01/31/2019GUNDERSEN CLINIC, LTD, 601 N SUPERIOR, TOMAH, WI 546602

01/09/2017 01/31/2019GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 1111 W WISCONSIN STREET, SPARTA, WI 546562

12/01/2016 01/31/2019GUNDERSEN LUTHERAN MEDICAL CENTER, 123 - 16TH AVE SOUTH, ONALASKA, WI 546502

12/01/2016 01/31/2019GUNDERSEN LUTHERAN MEDICAL CENTER, 3111 GUNDERSEN DRIVE, ONALASKA, WI 546502

05/02/2017 01/31/2019GUNDERSEN VIROQUA CLINIC, 407 SOUTH MAIN STREET, VIROQUA, WI 546652

06/26/2018 Page 58 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1520GUNDERSEN LUTHERAN MEDICAL CENTER, INC. BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201912/01/201603/01/1982

(608) 775-6055

(608) [email protected] THOMPSON

County: La CrosseLA CROSSE, WI 546011910 SOUTH AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2016 01/31/2019

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 12/01/2016 01/31/2019

CSAS-NARCOTIC TREATMENT DHS 75.15 12/01/2016 08/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 01/31/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 12/01/2016 01/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2016 01/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier02/05/2018 01/31/2019GUNDERSEN HARMONY CLINIC, 805 COUNTY ROAD 44, HARMONY, MN 559391

02/05/2018 01/31/2019GUNDERSEN HOUSTON CLINIC, 511 EAST MAPLE ST, HOUSTON, MN 559431

02/05/2018 01/31/2019GUNDERSEN SPRING GROVE CLINIC, 8123 5TH AVENUE SOUTHEAST, SPRING GROVE, MN 559741

02/05/2018 01/31/2019DAHL FAMILY YMCA, 1140 MAIN ST, LA CROSSE, WI 546012

12/01/2016 01/31/2019GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 124 NORTH COURT STREET, SPARTA, WI 546562

12/01/2016 01/31/2019GUNDERSEN LUTH MED CTR BEHAV HEALTH, 123 - 16TH AVENUE SOUTH, ONALASKA, WI 546502

12/01/2016 01/31/2019GUNDERSEN LUTH MED CTR BEHAV HEALTH, 18606 ERVIN STREET, WHITEHALL, WI 547732

12/01/2016 01/31/2019GUNDERSEN LUTH MED CTR BEHAV HEALTH, 3111 GUNDERSEN DRIVE, ONALASKA, WI 546502

12/01/2016 01/31/2019GUNDERSEN LUTH MED CTR BEHAV HEALTH, 601 N SUPERIOR AVENUE, TOMAH, WI 546602

12/01/2016 01/31/2019GUNDERSEN LUTH MED CTR BEHAV HEALTH, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 538212

1951GUNDERSEN LUTHERAN MEDICAL CENTER, INC. UNITY HOUSE FOR MEN

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201612/01/1993

(608) 775-4791

(608) [email protected] THOMPSON

County: La CrosseLA CROSSE, WI 546011922-1924 MILLER STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 12/01/2016 11/30/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

2782GUNDERSEN LUTHERAN MEDICAL CENTER, INC., UNITY HOUSE FOR MEN

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201612/01/2008

(608) 775-4791

(608) [email protected] THOMPSON

County: La CrosseLA CROSSE, WI 546011918-1920 MILLER STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 12/01/2016 11/30/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 59 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1952GUNDERSEN LUTHERAN MEDICAL CENTER, INC., UNITY HOUSE FOR WOMEN

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201611/01/1993

(608) 775-4710

(608) [email protected] THOMPSON

County: La CrosseLA CROSSE, WI 546011312 FIFTH AVENUE, SOUTH

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 12/01/2016 11/30/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

1488LA CROSSE COUNTY HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201802/01/1978

(608) 785-6122

(608) [email protected] TRUSSONI

County: La CrosseLA CROSSE, WI 54601300 N 4TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020LAKEVIEW HEALTH CENTER, 902 GARLAND ST, WEST SALEM, WI 546691

05/01/2018 04/30/2020RAVENWOOD, 902 GARLAND ST. EAST, WEST SALEM, WI 546691

05/01/2018 04/30/2020ROLLING HILLS, 14346 COUNTY HWY B, SPARTA, WI 546561

2935LA CROSSE COUNTY HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201801/19/2011

(608) 785-5715

(608) [email protected] SPANJERS

County: La CrosseLA CROSSE, WI 54601333 VINE STREET, ROOM 740

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 60 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1362MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201709/01/1977

(608) 392-9793

(608) [email protected] KNUTSON

County: La CrosseLA CROSSE, WI 54601212 S 11TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2017 05/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2017 05/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 06/01/2017 05/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2017 05/31/2019MAYO CLINIC FRANCISCAN - HOLMEN CLINIC, 1303 MAIN STREET, HOLMEN, WI 546362

06/01/2017 05/31/2019MAYO CLINIC FRANCISCAN - MENS RECOVERY HOUSE, 1005 JACKSON STREET, LA CROSSE, WI 54601

2

06/01/2017 05/31/2019MAYO CLINIC FRANCISCAN - ONALASKA CLINIC, 191 THEATER ROAD, ONALASKA, WI 546502

06/01/2017 05/31/2019MAYO CLINIC FRANCISCAN - PRAIRIE DU CHIEN CLINIC, 800 E BLACKHAWK AVENUE, PRAIRIE DU CHIEN, WI 53821

2

06/01/2017 05/31/2019MAYO CLINIC FRANCISCAN - SPARTA, 310 WEST MAIN STREET, SPARTA, WI 546562

06/01/2017 05/31/2019MAYO CLINIC FRANCISCAN - TOMAH, 325 BUTTS AVENUE, TOMAH, WI 546602

06/01/2017 05/31/2019MAYO CLINIC FRANCISCAN - WOMENS RECOVERY HOUSE, 518 SO 10TH STREET, LA CROSSE, WI 54601

2

06/01/2017 05/31/2019MAYO CLINIC FRANCISCAN MEDICAL CENTER, 800 WEST AVENUE SOUTH, LA CROSSE, WI 546012

06/01/2017 05/31/2019MAYO CLINIC FRANSISCAN - ARCADIA, 895 SO DETTLOFF DRIVE, ARCADIA, WI 546122

06/01/2017 05/31/2019MAYO CLINIC FRANSISCAN - GERARD HALL, 940 DIVISION STREET, LA CROSSE, WI 546012

1360MAYO CLINIC HEALTH SYSTEM - FRANCISCAN MEDICAL CENTER, INC MEN'S RECOVERY HOUSE

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/27/201701/01/1991

(608) 782-1811

(608) [email protected] SHERMAN

County: La CrosseLA CROSSE, WI 546011005 JACKSON STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 04/27/2017 03/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/27/2017 03/31/2019

Services

NO BRANCH LOCATIONS

2510MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER INC WOMEN'S RECOVERY HOUSE

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/19/2004

(608) 392-9511

(608) [email protected] CONWAY

County: La CrosseLA CROSSE, WI 54601518 SOUTH TENTH STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 04/01/2018 03/31/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 61 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3005PEACE OF MIND COUNSELING

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201608/01/2013

(608) 782-4426

(608) [email protected] CLARK

County: La CrosseLA CROSSE, WI 54601115 - 5TH AVENUE SOUTH, SUITE 507

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 07/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2016 07/31/2018PEACE OF MIND CNSLNG - WINONA MN, 902 E 2ND ST, SUITE 322, WINONA, MN 559872

05/26/2017 07/31/2018ARCADIA ELEMENTARY SCHOOL, 358 EAST RIVER ST, ARCADIA, WI 546123

05/26/2017 07/31/2018ARCADIA MIDDLE/HIGH SCHOOL, 756 RAIDER DR, ARCADIA, WI 546123

08/01/2016 07/31/2018BLAIR-TAYLOR SCHOOL DISTRICT, N31024 ELLAND ROAD, BLAIR, WI 546163

05/26/2017 07/31/2018CASHTON ELEMENTARY, 436 FRONT ST, CASHTON, WI 546193

03/28/2018 07/31/2018CATARACT ELEMENTARY SCHOOL, 6070 STATE HWY 27, SPARTA, WI 546563

08/01/2016 07/31/2018CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD, LA CROSSE, WI 546013

08/01/2016 07/31/2018COCHRANE-FOUNTAIN CITY SCHOOL DISTRICT, S2770 STATE HIGHWAY 35, FOUNTAIN CITY, WI 54629

3

08/01/2016 07/31/2018COULEE CONNECTIONS, 99 MILWAUKEE ST, LA CROSSE, WI 546013

08/01/2016 07/31/2018COULEE REGION ALTERNATIVE SCHOOL, 20873 COLLEGE AVENUE, GALESVILLE, WI 546303

05/26/2017 07/31/2018DE SOTO MIDDLE/HIGH SCHOOL, 615 MAIN ST, DE SOTO, WI 546243

08/01/2016 07/31/2018EMERSON ELEMENTARY SCHOOL, 2102 CAMPBELL ROAD, LA CROSSE, WI 546013

08/01/2016 07/31/2018EVERGREEN ELEMENTARY, 510 LONG COULEE ROAD, HOLMEN, WI 546363

08/01/2016 07/31/2018G-E-T ELEMENTARY SCHOOL - GALESVILLE, 17151 FRENCH RD, GALESVILLE, WI 546303

08/01/2016 07/31/2018G-E-T HIGH SCHOOL, 17511 NORTH MAIN ST, GALESVILLE, WI 546303

08/01/2016 07/31/2018G-E-T MIDDLE SCHOOL, 19650 PRAIRIE RIDGE LANE, GALESVILLE, WI 546303

08/01/2016 07/31/2018HAMILTON ELEMENTARY SCHOOL, 1111 SOUTH 7TH STREET, LA CROSSE, WI 546013

03/28/2018 07/31/2018HIGH POINT CHARTER SCHOOL, 201 E FRANKLIN ST, SPARTA, WI 546563

08/01/2016 07/31/2018HOLMEN HIGH SCHOOL, 1001 MCHUGH ROAD, HOLMEN, WI 546363

08/01/2016 07/31/2018HOLMEN MIDDLE SCHOOL, 502 N MAIN STREET, HOLMEN, WI 546363

03/16/2017 07/31/2018INDEPENDENCE K-12, 23786 INDEE BLVD, INDEPENDENCE, WI 547473

08/01/2016 07/31/2018LA CRESCENT ELEMENTARY, 504 SOUTH OAK STREET, LA CRESCENT, MN 559473

08/01/2016 07/31/2018LA CRESCENT MS/HS, 1301 LANCER BLVD, LA CRESCENT, MN 559473

03/28/2018 07/31/2018LAKEVIEW MONTESSORI SCHOOL, 711 PINE ST, SPARTA, WI 546563

03/28/2018 07/31/2018LAWRENCE-LAWSON ELEMENTARY SCHOOL, 429 N BLACK RIVER ST, SPARTA, WI 546563

05/26/2017 07/31/2018LOGAN HIGH SCHOOL, 1500 RANGER DR, LA CROSSE, WI 546013

03/28/2018 07/31/2018MAPLEWOOD ELEMENTARY SCHOOL, 900 E MONTGOMERY ST, SPARTA, WI 546563

03/28/2018 07/31/2018MEADOWVIEW INTERMEDIATE SCHOOL, 125 N WATER ST, SPARTA, WI 546563

05/26/2017 07/31/2018NORTHSIDE ELEMENTARY, 1611 KANE ST, LA CROSSE, WI 546013

08/01/2016 07/31/2018ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI 546503

08/01/2016 07/31/2018ONALASKA MIDDLE SCHOOL, 711 QUINCY STREET, ONALASKA, WI 546503

08/01/2016 07/31/2018PRAIRIE VIEW ELEMENTARY, 1201 NEWPORT LANE, HOLMEN, WI 546363

08/01/2016 07/31/2018SAND LAKE ELEMENTARY, 3600 SAND LAKE ROAD, HOLMEN, WI 546363

03/28/2018 07/31/2018SOUTHSIDE ELEMENTARY, 1023 WALRATH ST, SPARTA, WI 546563

03/28/2018 07/31/2018SPARTA ALT IND LEARNING SCHOOLS (SAILS), 201 E FRANKLIN ST, SPARTA, WI 546563

03/28/2018 07/31/2018SPARTA HIGH SCHOOL, 506 N BLACK RIVER ST, SPARTA, WI 546563

03/28/2018 07/31/2018SPARTA MEADOWVIEW MIDDLE SCHOOL, 1225 N BLACK RIVER ST, SPARTA, WI 546563

03/02/2017 07/31/2018STODDARD ELEMENTARY SCHOOL, 300 N. COTTAGE ST., STODDARD, WI 546583

08/01/2016 07/31/2018VIKING ELEMENTARY, 500 E WALL STREET, HOLMEN, WI 546363

08/01/2016 07/31/2018WHITEHALL SCHOOL DISTRICT, 19121 HOBSON ST, WHITEHALL, WI 547733

06/26/2018 Page 62 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3044WESTERN REGION INTEGRATED CARE CCS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201807/01/201607/04/2014

(608) 785-6122

(608) [email protected] ENGLING

County: La CrosseLA CROSSE, WI 54602300 - 4TH STREET NORTH

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 07/01/2016 06/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2016 06/30/2018JACKSON COUNTY HUMAN SERVICES - CCS, 420 COUNTY HWY 54 POX 457, BLACK RIVER FALLS,

WI 546152

07/01/2016 06/30/2018MONROE COUNTY HUMAN SERVICES CCS, 14301 COUNTY HWY B, SPARTA, WI 546562

3058WESTERN REGION INTEGRATED CARE CONSORTIUM (WRIC) CSP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201811/01/2014

(608) 785-0002

(608) [email protected] ROHR

County: La CrosseLA CROSSE, WI 546011707 MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019FAMILY & CHILDREN'S CENTER, JACKSON COUNTY OFFICE, 221 MAIN ST., STE. L101, BLACK RIVER

FALLS, WI 546152

01/01/2018 12/31/2019FAMILY & CHILDREN'S CENTER, MONROE COUNTY OFFICE, 920 WEST WISCONSIN, SPARTA, WI 54656

2

ONALASKA

2971ADDICTION MEDICAL SOLUTIONS OF WISCONSIN LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201609/17/2012

(608) 783-0242

(608) [email protected] BOLAN

County: La CrosseONALASKA, WI 546509532 EAST 16 FRONTAGE RD #100

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 09/01/2016 08/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2019

Services

NO BRANCH LOCATIONS

2280GUNDERSEN LUTHERAN MEDICAL CENTER, INC., BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201612/01/2000

(608) 775-8661

(608) [email protected] THOMPSON

County: La CrosseONALASKA, WI 54650123 - 16TH AVENUE, SOUTH

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2016 11/30/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 63 of 172

Substance Abuse Program Directory By County, City, and Provider Name

LAFAYETTEDARLINGTON

1490LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201710/01/1975

(608) 776-4914

(608) [email protected] SCHUHMACHER

County: LafayetteDARLINGTON, WI 5353015701 COUNTY ROAD K

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 11/01/2017 01/26/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

2279LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201711/01/2000

(608) 776-4914

(608) [email protected] SCHUHMACHER

County: LafayetteDARLINGTON, WI 5353015701 COUNTY ROAD K

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 64 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MANITOWOCKIEL

3060PATHWAYS TO A BETTER LIFE 1, LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/13/2015

(920) [email protected] COOPER

County: ManitowocKIEL, WI 5304213111 LAX CHAPEL RD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

3088PATHWAYS TO A BETTER LIFE 2, LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/15/2015

(920) [email protected] THOMPSON

County: ManitowocKIEL, WI 5304213127 LAX CHAPEL RD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/01/2018 04/30/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

MANITOWOC

1555MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201710/01/1975

(920) 683-4243

(920) [email protected] FURE

County: ManitowocMANITOWOC, WI 54220926 S. 8TH STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 11/01/2017 10/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2017 10/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

2285MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT CSP

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201710/01/1975

(920) 683-4243

(920) [email protected] FURE

County: ManitowocMANITOWOC, WI 54220926 S. 8TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 11/01/2017 10/31/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 65 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2711MANITOWOC COUNTY HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201702/06/2007

(920) 683-4243

(920) [email protected] FURE

County: ManitowocMANITOWOC, WI 54221926 S. 8TH STREET

CCS Affiliaton: 09/01/2014Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

TWO RIVERS

1591PHOENIX BEHAVIORAL HEALTH SERVICES, LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201804/24/201708/26/1991

(920) 657-1784

(920) [email protected] EIDEN, PHD

County: ManitowocTWO RIVERS, WI 542413120 MEMORIAL DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/24/2017 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/24/2017 10/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier04/24/2017 10/31/2018PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 1121 NORTH 7TH STREET, SHEBOYGAN, WI 530811

06/26/2018 Page 66 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MARATHONABBOTSFORD

2180COURAGE TO CHANGE RECOVERY

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201701/07/2000

(715) 223-1611

(715) 223-0480rwichlacz@couragetochangereoveryRAE ANN WICHLACZ

County: MarathonABBOTSFORD, WI 54405106 GALVIN ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2017 10/31/2019COURAGE TO CHANGE RECOVERY, 880 E PERKINS, #102, MEDFORD, WI 544512

WAUSAU

2873ACS CLINICAL SERVICES, LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201709/15/2009

(715) 355-0667

(715) [email protected] YEAGER

County: MarathonWAUSAU, WI 54403903 N 2ND STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

2464CHARIS COUNSELING, LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201609/01/2003

(715) 848-8665

(715) [email protected] THOMPSON

County: MarathonWAUSAU, WI 544012620 W. STEWART AVENUE, #310

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018CHARIS COUNSELING, LLC, 2000 WEST 5TH ST, MARSHFIELD, WI 544491

09/01/2016 08/31/2018CHARIS COUNSELING, LLC, 101 W MC MILLAN STREET, #2B, MARSHFIELD, WI 544492

04/12/2017 08/31/2018MERRILL HIGH SCHOOL, 1201 N SALES STREET, MERRILL, WI 544523

04/12/2017 08/31/2018PRAIRIE RIVER MIDDLE SCHOOL, 106 POLK STREET, MERRILL, WI 544523

2349DIX & GILLETTE COUNSELING SERVICES, LLP

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201802/01/2001

(715) 675-2988

(715) [email protected] DIX

County: MarathonWAUSAU, WI 544011720 MERRILL AVE SUITE 401

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 67 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1299ELMERGREEN ASSOCIATES, INC.

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201711/05/1992

(715) 845-7142

(715) [email protected] ELMERGREEN

County: MarathonWAUSAU, WI 54403114 GRAND AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

2408MILWAUKEE HEALTH SERVICES SYSTEM, LLC DBA WAUSAU COMPREHENSIVE TREATMENT CTR

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201805/02/201601/13/2003

(715) 845-1977

(715) [email protected] ZELECHOWSKI

County: MarathonWAUSAU, WI 54403210 WASHINGTON STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/02/2016 08/31/2018

CSAS-NARCOTIC TREATMENT DHS 75.15 05/02/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/02/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 68 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1677NORTH CENTRAL HEALTH CARE

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201710/01/1975

(715) 845-6050

(715) [email protected] LOY

County: MarathonWAUSAU, WI 544031100 LAKE VIEW DRIVE

Service Begin/End DatesAdm Code

CSAS-AMBULATORY DETOXIFICATION DHS 75.08 03/01/2017 02/28/2019

CSAS-DAY TREATMENT DHS 75.12 03/01/2017 02/28/2019

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2017 02/28/2019

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 03/01/2017 02/28/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2017 02/28/2019

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 03/01/2017 02/28/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2017 02/28/2019

MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2017 02/28/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2017 02/28/2019ANTIGO CENTER, 1225 LANGLADE ROAD, ANTIGO, WI 544092

03/01/2017 02/28/2019MERRILL CENTER, 607 N SALES STREET, #309, MERRILL, WI 544522

03/01/2017 02/28/2019TOMAHAWK OFFICE, 213 WEST WISCONSIN AVE, TOMAHAWK, WI 544872

Setting Begin/End DatesNon-Certified School Setting(s)03/01/2017 02/28/2019ATHENS HIGH SCHOOL, 601 WEST LIMITS ROAD, ATHENS, WI 54411

03/01/2017 02/28/2019DC EVEREST JUNIOR HIGH, 1000 MACHMUELLER STREET, WESTON, WI 54476

03/01/2017 02/28/2019DC EVEREST MIDDLE SCHOOL, 302 SCHOFIELD AVENUE, WESTON, WI 54476

03/01/2017 02/28/2019DC EVEREST SENIOR HIGH, 6500 ALDERSON STREET, SCHOFIELD, WI 54476

03/01/2017 02/28/2019FRANKLIN ELEMENTARY SCHOOL, 1509 NORTH 5TH STREET, WAUSAU, WI 54403

03/01/2017 02/28/2019MARATHON HIGH SCHOOL, 204 EAST STREET, MARATHON, WI 54448

03/01/2017 02/28/2019MOSINEE ELEMENTARY SCHOOL, 600 12TH STREET, MOSINEE, WI 54455

03/01/2017 02/28/2019MOSINEE HIGH SCHOOL, 1000 HIGH STREET, MOSINEE, WI 54455

03/01/2017 02/28/2019MOSINEE MIDDLE SCHOOL, 700 HIGH STREET, MOSINEE, WI 54455

03/01/2017 02/28/2019RIVERSIDE ELEMENTARY SCHOOL, 12231 RIVER ROAD, RINGLE, WI 54471

03/01/2017 02/28/2019ROTHSCHILD ELEMENTARY SCHOOL, 810 1ST STREET, ROTHSCHILD, WI 54474

03/01/2017 02/28/2019THOMAS JEFFERSON ELEMENTARY SCHOOL, 500 WEST RANDOLPH STREET, WAUSAU, WI 54401

03/01/2017 02/28/2019WAUSAU EAST HIGH SCHOOL, 2607 NORTH 18TH STREET, WAUSAU, WI 54403

03/01/2017 02/28/2019WESTON ELEMENTARY SCHOOL, 5200 CAMP PHILLIPS ROAD, SCHOFIELD, WI 54406

3041NORTH CENTRAL HEALTH CARE CCS

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201807/01/2014

(715) 841-5146

(715) [email protected] HINTZ

County: MarathonWAUSAU, WI 544031100 LAKE VIEW DRIVE

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL UNIFIED BOARD DHS 36 01/01/2018 12/31/2019

CCS REGIONAL MODEL UNIFIED BOARD W/TELEHEALTH DHS 36 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019NORTH CENTRAL HEALTH CARE - LANGLADE COUNTY, 1225 LANGLADE ROAD, ANTIGO, WI 544092

01/01/2018 12/31/2019NORTH CENTRAL HEALTH CARE - LINCOLN COUNTY, 607 N SALES ST STE 309, MERRILL, WI 544522

06/26/2018 Page 69 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2297NORTH CENTRAL HEALTH CARE CSP

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201810/01/1975

(715) 841-5146

(715) [email protected] HINTZ

County: MarathonWAUSAU, WI 544031100 LAKE VIEW DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 01/01/2018 12/31/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019NORTH CENTRAL HEALTH CARE CSP - LANGLADE, 1225 LANGLADE ROAD, ANTIGO, WI 544092

01/01/2018 12/31/2019NORTH CENTRAL HEALTH CARE CSP - LINCOLN, 607 N SALES ST STE 309, MERRILL, WI 544522

2715PEACEFUL SOLUTIONS COUNSELING

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2007

(715) 675-7238

(715) [email protected] SHIPWAY

County: MarathonWAUSAU, WI 54403741 NORTH 1ST STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020PEACEFUL SOLUTIONS COUNSELING, 726 EAST 2ND STREET, MERRILL, WI 544521

03/01/2018 02/29/2020EDGAR MIDDLE/HIGH SCHOOL, 203 E. BIRCH STREET, EDGAR, WI 544263

03/01/2018 02/29/2020WAUSAU EAST HIGH SCHOOL, 2607 NORTH 18TH STREET, WAUSAU, WI 544033

1909THE CENTRE FOR WELL-BEING, INC.

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201702/17/1992

(888) 778-6750

(715) [email protected] SALZMAN

County: MarathonWAUSAU, WI 54403901 N 6TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2019THE CENTRE FOR WELL-BEING, 1415 EAGLE STREET, RHINELANDER, WI 545011

10/19/2017 08/31/2019THE CENTRE FOR WELL-BEING, 6001 BUSINESS HWY 51 S, WESTON, WI 544762

09/01/2017 08/31/2019THE CENTRE FOR WELL-BEING, 607 CEDAR AVE, MERRILL, WI 544522

09/01/2017 08/31/2019LAC DU FLAMBEAU ELEMENTARY SCHOOL, 2899 HWY 47, LAC DU FLAMBEAU, WI 545383

10/19/2017 08/31/2019WAUSAU WEST HIGH SCHOOL, 1200 WEST WAUSAU AVENUE, WAUSAU, WI 544013

06/26/2018 Page 70 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WESTON

2939COMPASS COUNSELING WAUSAU, LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/25/2011

(715) 848-5645

(715) [email protected] PETERSON

County: MarathonWESTON, WI 544763704 WESTON AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020COMPASS COUNSELING WAUSAU, LLC, 420 THIRD ST S, WISCONSIN RAPIDS, WI 544942

04/01/2018 03/31/2020COMPASS COUNSELING WAUSAU, LLC, 530 GRANT ST, WAUSAU, WI 544032

04/01/2018 03/31/2020ADAMS FRIENDSHIP ELEMENTARY, 500 N PIERCE ST, ADAMS, WI 539103

04/01/2018 03/31/2020ADAMS FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 539103

04/01/2018 03/31/2020ADAMS FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 539103

06/26/2018 Page 71 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MARINETTEMARINETTE

3074MARINETTE AND OCONTO COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201610/01/2015

(715) 732-7711

(715) [email protected] GERBYSHAK

County: MarinetteMARINETTE, WI 541432500 HALL AVE

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 10/01/2016 09/30/2018

CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 36 10/01/2016 09/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2016 09/30/2018OCONTO COUNTY DEPT. OF HEALTH AND HUMAN SERVICES, 501 PARK AVE., OCONTO, WI 541531

1559MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT / ADAPT

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201701/01/1982

(715) 732-7711

(715) [email protected] FREEMAN

County: MarinetteMARINETTE, WI 541432500 HALL AVENUE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 12/01/2017 11/30/2019

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 12/01/2017 11/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 12/01/2017 11/30/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/01/2017 11/30/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 12/01/2017 11/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2017 11/30/2019MARINETTE COUNTY HHSD/ADAPT, 1201 JACKSON STREET, NIAGARA, WI 541512

2340MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT/ADAPT CSP

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201701/01/1982

(715) 732-7667

(715) [email protected] BREAULT

County: MarinetteMARINETTE, WI 541432500 HALL AVENUE, #A

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

3117ST VINCENT HHS OF THE THIRD ORDER OF ST FRANCIS DBA LIBERTAS OF MARINETTE

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2016

(715) 735-0094

(715) [email protected] BEHNKE

County: MarinetteMARINETTE, WI 541431409 CLEVELAND AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 72 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MARQUETTEMONTELLO

1560MARQUETTE COUNTY HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201805/01/201603/01/1981

(608) 297-2148

(608) [email protected] RASMUSSEN

County: MarquetteMONTELLO, WI 53949480 UNDERWOOD AVE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 05/01/2016 04/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2016 04/30/2018

CSAS-PREVENTION DHS 75.04 05/01/2016 04/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2016 04/30/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2016 04/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2016 04/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier10/22/2016 04/30/2018MONTELLO SCHOOLS, 222 FOREST LANE, MONTELLO, WI 539493

10/22/2016 04/30/2018WESTFIELD ELEMENTARY SCHOOL, 329 HAWK LANE, WESTFIELD, WI 539643

10/22/2016 04/30/2018WESTFIELD MIDDLE/HIGH SCHOOL, N7046 COUNTY ROAD M, WESTFIELD, WI 539643

3108MARQUETTE COUNTY HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/01/2016

(608) 297-2148

(608) [email protected] STARKS

County: MarquetteMONTELLO, WI 53949480 UNDERWOOD AVE

CCS Affiliaton: 01/01/2016Begin: End: Lead:Central Wisconsin Health Partnership V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2017 12/31/2018

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

3125MARQUETTE COUNTY HUMAN SERVICES - CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/28/2016

(608) 297-2148

(608) [email protected] RASMUSSEN

County: MarquetteMONTELLO, WI 53949480 UNDERWOOD AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 03/01/2017 02/28/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 73 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MENOMINEEKESHENA

1587MENOMINEE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201711/01/1994

(715) 799-3517

(715) [email protected] KIELBLOCK

County: MenomineeKESHENA, WI 54135W3272 WOLF RIVER ROAD

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 05/01/2017 04/30/2019

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 05/01/2017 04/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2017 04/30/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 05/01/2017 04/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2017 04/30/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2017 04/30/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2017 04/30/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

2228MENOMINEE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT CSP

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201711/01/1994

(715) 799-3517

(715) [email protected] KIELBLOCK

County: MenomineeKESHENA, WI 54135W3272 WOLF RIVER ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 74 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MILWAUKEEBROWN DEER

2882REACH, INC. COMPREHENSIVE MENTAL HEALTH CLINIC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201609/01/2009

(414) 961-1616

(414) [email protected] YELVINGTON

County: MilwaukeeBROWN DEER, WI 532234550 W BRADLEY ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

2532ROGERS MEMORIAL HOSPITAL - CHILD & ADOLESCENT DAY TREATMENT

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/13/2004

(414) 355-9665

(414) [email protected] SCHULTZ

County: MilwaukeeBROWN DEER, WI 532234555 W SCHROEDER DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2017 06/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2017 06/30/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2017 06/30/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 07/01/2017 06/30/2019

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

3084ROGERS MEMORIAL HOSPITAL, INC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/28/2015

(262) 646-1330

(414) [email protected] SCHULTZ

County: MilwaukeeBROWN DEER, WI 532234600 WEST SCHROEDER DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 04/01/2018 03/31/2020

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 04/01/2018 03/31/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 04/01/2018 03/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 75 of 172

Substance Abuse Program Directory By County, City, and Provider Name

CUDAHY

1867AURORA HEALTH CARE METRO, INC. DBA AURORA ST. LUKE'S SOUTH SHORE

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201611/01/1989

(414) 489-4056

(414) [email protected] SHANKS

County: MilwaukeeCUDAHY, WI 531105900 S. LAKE DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2016 09/30/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/2016 09/30/2018

MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2016 09/30/2018

Services

NO BRANCH LOCATIONS

FRANKLIN

1650AURORA BEHAVIORAL HEALTH - FRANKLIN

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201907/31/201705/02/1994

(417) 773-4352

(414) [email protected] MONSON-DUPUIS

County: MilwaukeeFRANKLIN, WI 531329200 W. LOOMIS ROAD, #217

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/31/2017 04/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/31/2017 04/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/31/2017 04/30/2019AURORA BEHAVIORAL HEALTH CENTER - LAYTON, 2000 E. LAYTON AVE., STE 250, SAINT FRANCIS,

WI 532352

07/31/2017 04/30/2019AURORA BEHAVIORAL HEALTH CENTER-LAKESHORE, 3611 CHICAGO AVE, SOUTH MILWAUKEE, WI 53172

2

07/31/2017 04/30/2019AURORA BEHAVIORAL SERVICES-MUSKEGO WEST, S74W16775 JANESVILLE RD, MUSKEGO, WI 53150

2

GLENDALE

3155AURORA PSYCHIATRIC HOSPITAL INC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201709/29/2016

(414) 454-6450

(414) [email protected] SURFUS-LEWISTON

County: MilwaukeeGLENDALE, WI 532176980 N PORT WASHINGTON ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 09/01/2017 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 76 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2367LA CAUSA, INC.

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201704/22/2002

(414) 771-7497

(414) [email protected] CORTEZ

County: MilwaukeeGLENDALE, WI 532095235 N IRONWOOD ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2017 04/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

1836SHOREHAVEN BEHAVIORAL HEALTH INC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1983

(414) 540-2171

(414) [email protected] GODEC

County: MilwaukeeGLENDALE, WI 532093900 W BROWN DEER ROAD #200

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020SHOREHAVEN BEHAVIORAL HEALTH INC, 4370 SOUTH 76TH STREET, GREENFIELD, WI 532202

07/01/2018 06/30/2020SHOREHAVEN BEHAVIORAL HEALTH, INC., 2607 N GRANDVIEW BLVD., # 102, WAUKESHA, WI 531882

07/01/2018 06/30/2020SHOREHAVEN BEHAVIORAL HEALTH, INC., 6233 DURAND AVE #F, RACINE, WI 534062

GREENFIELD

1095BELL THERAPY COMMUNITY SUPPORT PROGRAM SOUTH

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201703/03/1997

(414) 210-2222

(414) [email protected] ZOCH

County: MilwaukeeGREENFIELD, WI 532284420 SOUTH 108TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

3091SERENITY RECOVERY CLINIC LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/08/2015

(414) 763-7755

(414) [email protected] LUZNICKY CSAC

County: MilwaukeeGREENFIELD, WI 532206510 W LAYTON AVE, STE 5

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 77 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MILWAUKEE

26822ND CENTURY

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201708/30/2006

(414) 321-5935

(414) [email protected] SANCHEZ

County: MilwaukeeMILWAUKEE, WI 532272187 S 85TH STREET

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

2982A STRONG FOUNDATION COUNSELING SERVICES, LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201612/01/201511/06/2012

(414) 967-7991

(414) [email protected] COLLINS

County: MilwaukeeMILWAUKEE, WI 532114447 N OAKLAND AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2015 10/31/2016

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2015 10/31/2016

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2015 10/31/2016

Services

NO BRANCH LOCATIONS

3119ACCESS RECOVERY MENTAL HEALTH SERVICES (ARMHS)

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/10/2016

(414) 455-1915

(414) [email protected] YAROW

County: MilwaukeeMILWAUKEE, WI 532152727 WEST CLEVELAND AVE, #204

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2018 02/29/2020

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

2992ACS CLINICAL SERVICES LLC - MILWAUKEE

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201803/01/201603/01/2013

(414) 277-7938

(414) [email protected] SCHABEL

County: MilwaukeeMILWAUKEE, WI 532022266 N PROSPECT AVE, SUITES 204 & 520

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 02/28/2018

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2016 02/28/2018ACS CLINICAL SERVICES, LLC - MADISON, 7017 RAYWOOD ROAD, MADISON, WI 537132

03/01/2016 02/28/2018ACS CLINICAL SERVICES, LLC - WAUKESHA, 217 WISCONSIN AVE, SUITE 209, WAUKESHA, WI 531872

06/26/2018 Page 78 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2406AIDS RESOURCE CENTER OF WISCONSIN

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201710/02/2002

(414) 225-1628

(414) [email protected] LEWIS

County: MilwaukeeMILWAUKEE, WI 53203820 N. PLANKINTON AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2017 12/31/2018

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 08/09/2017 12/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2017 12/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/09/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/09/2017 12/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2017 12/31/2018AIDS RESOURCE CENTER OF WI-KENOSHA, 1212 - 57TH STREET, KENOSHA, WI 531401

01/01/2017 12/31/2018AIDS RESOURCE CENTER OF WI-LA CROSSE, 505 KING STREET, LA CROSSE, WI 546011

01/01/2017 12/31/2018AIDS RESOURCE CENTER OF WISCONSIN, 633 C WEST WISCONSIN AVE, APPLETON, WI 549111

01/01/2017 12/31/2018AIDS RESOURCE CENTER OF WI-WAUSAU, 1105 GRAND AVENUE, #1, WAUSAU, WI 544031

01/01/2017 12/31/2018AIDS RESOURCE ENTER OF WI-EAU CLAIRE, 505 DEWEY STREET SOUTH, #107, EAU CLAIRE, WI 54702

1

01/01/2017 12/31/2018ARCW, 136 W. GRAND AVENUE, BELOIT, WI 535111

01/01/2017 12/31/2018ARCW, 600 WILLIAMS STREET, MADISON, WI 537031

01/01/2017 12/31/2018AIDS RESOURCE CENTER OF WI-GREEN BAY, 445 S ADAMS STREET, GREEN BAY, WI 543012

2875AMRI COUNSELING SERVICES, LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201608/01/2009

(866) 719-3024

(414) [email protected] JONES

County: MilwaukeeMILWAUKEE, WI 532164001 WEST CAPITOL DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2016 07/31/2018

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 08/01/2016 07/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2016 07/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/01/2016 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2016 07/31/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2016 07/31/2018

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 08/01/2016 07/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2016 07/31/2018AMRI COUNSELING SERVICES, 6321 23RD AVENUE, KENOSHA, WI 531431

11/01/2017 07/31/2018MILWAUKEE ACADEMY OF SCIENCE, 2000 W KILBOURN AVE, MILWAUKEE, WI 532333

3069ARC MILWAUKEE WOMEN'S PROGRAM

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201712/11/2014

(414) 837-6062

(414) [email protected] WOLKOMIR

County: MilwaukeeMILWAUKEE, WI 532011022 W MADISON STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 79 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3146ARUNAOBI INTEGRATED MEDICAL BEHAVIORAL HEALTH CLINIC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201710/06/2016

(414) 810-0587

(414) [email protected] A ANIAKUDO

County: MilwaukeeMILWAUKEE, WI 532105325 W BURLEIGH ST

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 09/01/2017 08/31/2018

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 09/01/2017 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2017 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2017 08/31/2018

Services

NO BRANCH LOCATIONS

1335AURORA BEHAVIORAL HEALTH NORTH SHORE

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201608/01/1985

(414) 454-6450

(414) [email protected] MONSON-DUPUIS

County: MilwaukeeMILWAUKEE, WI 532176980 N PORT WASHINGTON #202

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2016 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 07/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2016 07/31/2018AURORA BEHAVIORAL HEALTH - HARTFORD, 1640 E SUMNER STREET, HARTFORD, WI 530271

08/01/2016 07/31/2018AURORA BEHAVIORAL HEALTH - GRAFTON, 975 N. PORT WASHINGTON RD, GRAFTON, WI 530242

08/01/2016 07/31/2018AURORA BEHAVIORAL HEALTH - WEST BEND, 205 VALLEY AVENUE, WEST BEND, WI 530952

1839AURORA BEHAVIORAL HEALTH CENTER - SINAI

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201810/01/1987

(414) 454-6450

(414) [email protected] MONSON-DUPUIS

County: MilwaukeeMILWAUKEE, WI 532331020 N 12TH ST 4TH FLOOR

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

1093BELL THERAPY INC COMMUNITY SUPPORT PROGRAM NORTH

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201709/01/1990

(414) 871-2552

(414) [email protected] WRIGHT

County: MilwaukeeMILWAUKEE, WI 532164929 W FOND DU LAC AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 80 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2456BENEDICT CENTER WOMEN'S HARM REDUCTION PROGRAM

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/15/2003

(414) 347-0148

(414) [email protected] PERRY

County: MilwaukeeMILWAUKEE, WI 532121849 MARTIN LUTHER KING DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

1870COLUMBIA ST. MARY'S BEHAVIORAL MEDICINE - MILWAUKEE

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201806/01/1981

(414) 585-1969

(414) [email protected] MCGLYNN

County: MilwaukeeMILWAUKEE, WI 532112323 N LAKE DRIVE, 7TH FLOOR

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2018 12/31/2019

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2018 12/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

1215COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE CAMPUS

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201807/01/201607/01/2015

(414) 585-1924

(414) [email protected] PEERBOLT

County: MilwaukeeMILWAUKEE, WI 532112301 N LAKE DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2016 06/30/2018

MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2016 06/30/2018

Services

NO BRANCH LOCATIONS

3123COMMUNITY ADVOCATES, PUBLIC POLICY INSTITUTE

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201705/01/2016

(414) 270-2971

(414) [email protected] ELLIOT

County: MilwaukeeMILWAUKEE, WI 53233728 N JAMES LOVELL STREET

Service Begin/End DatesAdm Code

CSAS-PREVENTION DHS 75.04 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 81 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3153CROSSROADS COGNITIVE BEHAVIORAL SERVICES

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201804/01/201810/01/2016

(414) 562-6361

(414) [email protected] MCCLENDON

County: MilwaukeeMILWAUKEE, WI 532052454 WEST LISBON AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 09/30/2018

Services

NO BRANCH LOCATIONS

2953EMPATHETIC COUNSELING SERVICES INC.

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201612/01/2011

(414) 332-2523

(414) [email protected] BROUGHTON LEWIS

County: MilwaukeeMILWAUKEE, WI 532166815 WEST CAPITOL DRIVE #311

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2017 11/30/2018EMPATHETIC COUNSELING SERVICES SOUTH, 610 WEST LINCOLN AVE SUITE 2C, MILWAUKEE, WI

532042

2473FOKUS FAMILY SERVICES

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2014

(414) 264-4218

(414) [email protected] COLLINS

County: MilwaukeeMILWAUKEE, WI 532122821 N. 4TH STREET, #139

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

3174FOREVER FREE SUBSTANCE ABUSE & MENTAL HEALTH TREATMENT CENTER

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/24/201708/24/2017

(414) 383-8627

(414) [email protected] CHARLES GREEN

County: MilwaukeeMILWAUKEE, WI 53215724 S LAYTON BLVD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/24/2017 07/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 82 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2479GATEWAY TO CHANGE

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201610/29/2003

(414) 442-2167

(414) [email protected] HAMPTON

County: MilwaukeeMILWAUKEE, WI 532062319 W. CAPITOL DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2016 11/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

1383GENESIS BEHAVIORAL SERVICES, INC. MEN'S AODA RESIDENTIAL

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201801/01/201707/15/1992

(414) 449-3993

(414) [email protected] SANCHEZ

County: MilwaukeeMILWAUKEE, WI 532102436 N 50TH STREET

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 01/01/2017 07/31/2018

Services

NO BRANCH LOCATIONS

2803GRO FAMILY SERVICES

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201902/21/201808/28/2008

(414) 395-4716

(414) [email protected] OWENS

County: MilwaukeeMILWAUKEE, WI 532102436 NORTH 50TH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 02/21/2018 07/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/21/2018 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/21/2018 07/31/2019

Services

NO BRANCH LOCATIONS

2101GUEST HOUSE COUNSELING CLINIC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201707/15/1992

(414) 345-3258

(414) [email protected] VAREKA

County: MilwaukeeMILWAUKEE, WI 532051216 N. 13TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 83 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2174HORIZON HEALTHCARE INC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201711/01/1999

(414) 762-9727

(414) [email protected] SANCHEZ

County: MilwaukeeMILWAUKEE, WI 532074650 S HOWELL AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 12/01/2017 11/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/16/2018 11/30/2019HORIZON HEALTHCARE INC, 1146 GRANT STREET, BELOIT, WI 535112

12/01/2017 11/30/2019HORIZON HEALTHCARE INC, 1648 WASHINGTON AVENUE, RACINE, WI 534032

12/01/2017 11/30/2019HORIZON HEALTHCARE INC, 3410 80TH STREET, KENOSHA, WI 531422

12/01/2017 11/30/2019HORIZON HEALTHCARE INC, 5408 W BURLEIGH ST, MILWAUKEE, WI 532102

3087INNER CITY BEHAVIORAL SERVICES, LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2015

(414) 444-2732

(414) [email protected] TRIPP

County: MilwaukeeMILWAUKEE, WI 532083341 WEST NORTH AVENUE #101

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

2033JEANNETTA ROBINSON HOUSE

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201907/07/201705/15/1998

(414) 536-3708

(414) [email protected] SANCHEZ

County: MilwaukeeMILWAUKEE, WI 532185427 W VILLARD STREET

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/07/2017 05/31/2019

Services

NO BRANCH LOCATIONS

1876LAD LAKE - ST ROSE CENTER

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201607/05/1985

(414) 466-0730

(414) [email protected] WALDRON

County: MilwaukeeMILWAUKEE, WI 532223801 N. 88TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018LAD LAKE, INC. DOUSMAN, W350 - S1401 WATERVILLE ROAD, DOUSMAN, WI 531181

06/26/2018 Page 84 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3045LIFE CHANGING MINISTRIES INC.

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/16/2014

(414) 755-0698

(414) [email protected] CHELSKY

County: MilwaukeeMILWAUKEE, WI 532051134 W NORTH AVE, 2ND FLOOR

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3039LOCKETT ENTERPRISES, LLC BEHAVIORAL HEALTH SERVICES

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201707/29/2014

(414) 223-3817

(414) [email protected] LOCKETT JR.

County: MilwaukeeMILWAUKEE, WI 532021845 NORTH FARWELL AVE SUITE 301

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2017 07/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

1573MATT TALBOT RECOVERY CENTER

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/07/1997

(414) 342-5476

(414) [email protected] SANCHEZ

County: MilwaukeeMILWAUKEE, WI 532052613 W. NORTH AVENUE

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

3072MATT TALBOT RECOVERY SERVICES INC (FIRST STEP COMMUNITY RECOVERY CTR)

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201802/05/2015

(414) 301-6383

(414) [email protected] SANCHEZ

County: MilwaukeeMILWAUKEE, WI 532102835 N 32ND STREET

Service Begin/End DatesAdm Code

CSAS-AMBULATORY DETOXIFICATION DHS 75.08 02/01/2018 01/31/2020

CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 02/01/2018 01/31/2020

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 85 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3062MATTERS OF THE SPIRIT, LLC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201801/01/2015

(414) 393-0492

(414) [email protected] TINA SANFORD

County: MilwaukeeMILWAUKEE, WI 532226815 WEST CAPITOL DRIVE, SUITE 112

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 05/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2019

Services

NO BRANCH LOCATIONS

1580MCW DEPARTMENT OF PSYCHIATRY CLINICS AT TOSA

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201707/01/1996

(414) 955-6285

(414) [email protected] G MILLER

County: MilwaukeeMILWAUKEE, WI 532261155 N MAYFAIR ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2017 01/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 02/01/2017 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2017 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

2225MD THERAPY

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201805/05/2000

(414) 466-3206

(414) [email protected] (MIKE) DALE

County: MilwaukeeMILWAUKEE, WI 532166815 W CAPITOL DRIVE, #208

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

1619META HOUSE, INC (SHOREWOOD CAMPUS) AKA META III

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201702/01/1995

(414) 962-2305

(414) [email protected] ULLSTRUP

County: MilwaukeeMILWAUKEE, WI 532113924-26 N. MARYLAND AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 02/01/2017 01/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 86 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2022META HOUSE, INC (SOUTH CAMPUS) AKA RIVERWEST

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201705/20/1998

(414) 962-2305

(414) [email protected] ULLSTRUP

County: MilwaukeeMILWAUKEE, WI 532122618 N. BREMEN STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 02/01/2017 01/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

2172META HOUSE, INC.

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201711/24/1999

(414) 962-2305

(414) [email protected] ULLSTRUP

County: MilwaukeeMILWAUKEE, WI 532122625 N WEIL STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2017 11/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

1620META HOUSE, INC. (NORTH CAMPUS)

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201702/01/1995

(414) 962-2305

(414) [email protected] ULLSTRUP

County: MilwaukeeMILWAUKEE, WI 532122626 N. BREMEN STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 08/01/2017 07/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

1933MILWAUKEE CENTER FOR INDEPENDANCE DBA WHOLE HEALTH CLINICAL GROUP

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201709/01/1985

(414) 615-0627

(414) [email protected] MCGUIRE

County: MilwaukeeMILWAUKEE, WI 53214932 S 60TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2017 05/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2017 05/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2017 05/31/2019CRISIS RESOURCE CENTER, 2057 S 14TH STREET, MILWAUKEE, WI 532041

06/01/2017 05/31/2019CRISIS RESOURCE CENTER, 5409 W VILLARD AVE, MILWAUKEE, WI 532181

06/01/2017 05/31/2019NEXDAY, 3333 SOUTH HOWELL AVE, MILWAUKEE, WI 532071

06/26/2018 Page 87 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3037MILWAUKEE COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201709/01/2014

(414) 257-8085

AMY LORENZ

County: MilwaukeeMILWAUKEE, WI 532269455 WEST WATERTOWN PLANK ROAD

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 09/01/2017 08/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2019MILWAUKEE CO DISABILITY SVS, 1220 W VLIET ST, MILWAUKEE, WI 532051

10/23/2017 08/31/2019ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, 6737 W WASHINGTON ST #1325, WEST ALLIS, WI 53214

2

09/01/2017 08/31/2019ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, SC, 10045 W LISBON AVENUE, MILWAUKEE, WI 53222

2

09/01/2017 08/31/2019BELL THERAPY, INC, 3090 N 53RD STREET, MILWAUKEE, WI 532102

09/01/2017 08/31/2019JUSTICE POINT, 205 W HIGHLAND AVE #314, MILWAUKEE, WI 532332

09/01/2017 08/31/2019LA CAUSA, INC, 5235 N IRONWOOD RD, GLENDALE, WI 532172

09/01/2017 08/31/2019MCFI DBA WHOLE HEALTH GROUP, 932 SOUTH 60TH STREET, MILWAUKEE, WI 532142

09/01/2017 08/31/2019MILWAUKEE MENTAL HEALTH ASSOCIATES, INC, 3975 N 68TH STREET, MILWAUKEE, WI 532162

09/01/2017 08/31/2019OUTREACH COMMUNITY HEALTH CENTERS, INC, 711 W CAPITOL DRIVE, MILWAUKEE, WI 532062

09/01/2017 08/31/2019PROJECT ACCESS, INC, 823 S 60TH ST, MILWAUKEE, WI 532142

09/29/2017 08/31/2019SAINT A, 8901 W CAPITOL DR, MILWAUKEE, WI 532222

09/01/2017 08/31/2019ST CHARLES YOUTH & FAMILY SERVICES, INC, 4757 N 76TH STREET, MILWAUKEE, WI 532182

09/01/2017 08/31/2019THE GUEST HOUSE OF MILWAUKEE, 1216 N 13TH STREET, MILWAUKEE, WI 532052

09/01/2017 08/31/2019WISCONSIN COMMUNITY SERVICES, 3732 W WISCONSIN AVE. SUITE 200, MILWAUKEE, WI 532082

1644MILWAUKEE HEALTH SERVICES SYSTEM, LLC DBA 10TH STREET COMPREHENSIVE TREATMENT CT

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201610/01/1995

(414) 744-9052

(414) [email protected] CRANE

County: MilwaukeeMILWAUKEE, WI 532214800 S 10TH STREET #1

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

1643MILWAUKEE HEALTH SERVICES SYSTEM, LLC DBA RIVERS SHORE COMPREHENSIVE TREATMENT C

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201611/01/1986

(414) 967-7020

(414) [email protected] OKETCH

County: MilwaukeeMILWAUKEE, WI 532123707 N RICHARDS STREET

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 88 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1645MILWAUKEE MENTAL HEALTH ASSOCIATES COMMUNITY SUPPORT PROGRAM

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201702/18/1997

(414) 873-4990

(414) [email protected] NOBLE

County: MilwaukeeMILWAUKEE, WI 532163975 N 68TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/01/2017 07/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/16/2017 07/31/2019MILWAUKEE MENTAL HEALTH ASSOCIATES, INC - NATIONAL, 3073 S CHASE AVE, SUITE 100,

MILWAUKEE, WI 532072

2891MINDSTAR COUNSELING, LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201806/15/201712/01/2009

(414) 435-0543

(414) 435-1115mindstarcounseling@mindstarcounsSTARLETTE PATTERSON

County: MilwaukeeMILWAUKEE, WI 532227900 W BURLEIGH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 04/25/2018 11/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/23/2018 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/15/2017 11/30/2018

Services

NO BRANCH LOCATIONS

1794MWCCA BEHAVIORAL HEALTH CLINIC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201908/01/201702/01/1988

(414) 270-2971

(414) [email protected] LOCKETT JR

County: MilwaukeeMILWAUKEE, WI 532164906 W FOND DU LAC AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2017 06/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

2930NEW CHOICES, LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201710/14/2010

(414) 444-8432

(414) [email protected] WILLIAMS

County: MilwaukeeMILWAUKEE, WI 532123565 N MARTIN LUTHER KING DR

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 89 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2413OMNI ENRICHMENT, INC.

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201702/01/2003

(414) 455-3292

(414) [email protected] TRIPP

County: MilwaukeeMILWAUKEE, WI 532083020 W. VLIET STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

1777OUTREACH COMMUNITY HEALTH CENTER INC RECOVERY CSP

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/17/1996

(414) 374-7917

(414) [email protected] GABRIEL

County: MilwaukeeMILWAUKEE, WI 53206711 W CAPITOL DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

2246OUTREACH COMMUNITY HEALTH CENTERS INC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201708/01/2000

(414) 727-6321

(414) [email protected] SANDERS

County: MilwaukeeMILWAUKEE, WI 53212210 W CAPITOL DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2017 07/31/2019OUTREACH COMMUMITY HEALTH CENTERS, 9120 W HAMPTON AVE, MILWAUKEE, WI 532252

08/01/2017 07/31/2019OUTREACH COMMUNITY HEALTH CENTER, 711 W CAPITOL DRIVE, MILWAUKEE, WI 532062

2990PARADIGM ENRICHMENT SERVICES, INC.

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/25/2013

(414) 393-1155

(414) [email protected] JACKSON II

County: MilwaukeeMILWAUKEE, WI 532164222 WEST CAPITOL DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 90 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3152PATHWAY YOUTH & FAMILY SERVICES

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201711/30/201611/30/2016

(414) 539-3636

(414) [email protected] RICHARDSON

County: MilwaukeeMILWAUKEE, WI 532123879 N PORT WASHINGTON RD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/30/2016 10/31/2017

Services

NO BRANCH LOCATIONS

2796POSITIVE OUTLOOK CLINICAL SERVICES LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201801/06/201708/01/2008

(414) 355-5467

(414) [email protected] HANSEN

County: MilwaukeeMILWAUKEE, WI 532166815 W CAPITOL DR, SUITE 304

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/06/2017 07/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/06/2017 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/06/2017 07/31/2018

Services

NO BRANCH LOCATIONS

1751PROJECT ACCESS, INC. CSP

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201712/20/1995

(414) 456-1655

(414) [email protected] ROGER ZHONG

County: MilwaukeeMILWAUKEE, WI 53214823 S 60TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

2118RAVENSWOOD CLINIC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201706/23/1999

(414) 224-8112

(414) [email protected] F. WERTH, JR.

County: MilwaukeeMILWAUKEE, WI 532022266 N. PROSPECT AVENUE, #326

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 09/01/2017 08/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

1792RENEW COUNSELING SERVICES

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201704/01/1985

(414) 727-8730

(414) [email protected] CROATT

County: MilwaukeeMILWAUKEE, WI 532041225 W. MITCHELL STREET, #223

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 91 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3181RESURRECTION CONSULTING SERVICES INC RCS

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/29/201708/29/2017

(414) 488-9850

(414) [email protected] ROSS

County: MilwaukeeMILWAUKEE, WI 532106040 W LISBON AVE SUITE 104

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/29/2017 07/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/29/2017 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/29/2017 07/31/2018

Services

NO BRANCH LOCATIONS

3038ROOTS COUNSELING SERVICES

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/16/2014

(414) 446-3317

(414) [email protected] A. JAEGER

County: MilwaukeeMILWAUKEE, WI 532021681 N PROSPECT AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2017 06/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

3175SAQH

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201801/16/201809/25/2017

(414) 431-8608

(414) [email protected] ALI

County: MilwaukeeMILWAUKEE, WI 532124111 N PORT WASHINGTON RD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/16/2018 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/16/2018 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier05/02/2018 08/31/2018SAQH WEST, 13000 W BLUEMOUND RD, ELM GROVE, WI 531222

06/26/2018 Page 92 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2495SEBASTIAN FAMILY PSYCHOLOGY PRACTICE LLC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/14/2004

(414) 247-0816

(414) [email protected] SSEMPIJJA

County: MilwaukeeMILWAUKEE, WI 532091720 W FLORIST AVENUE #125

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2017 12/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2017 12/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2017 12/31/2018SEBASTIAN FAMILY PSYCHOLOGY, 2745 W LAYTON AVE, STE 203, MILWAUKEE, WI 532211

01/01/2017 12/31/2018AUDUBON TECHNOLOGY & COMMUNICATION CENTER, 3300 S 39TH ST, MILWAUKEE, WI 532153

01/25/2017 12/31/2018BENJAMIN FRANKLIN SCHOOL, 2308 W NASH ST, MILWAUKEE, WI 532063

01/25/2017 12/31/2018BETHUNE ACADEMY, 1535 N 35TH ST, MILWAUKEE, WI 532083

01/25/2017 12/31/2018HENRY DAVID THOREAU, 7878 N 60TH ST, MILWAUKEE, WI 532233

01/25/2017 12/31/2018MILW COLLEGE PREP LLOYD ST, 1228 W LLOYD ST, MILWAUKEE, WI 532053

01/01/2017 12/31/2018OLIVER WENDALL HOLMES SCHOOL, 2463 N BUFFUM ST, MILWAUKEE, WI 532123

01/25/2017 12/31/2018SHERMAN MULTICULTURAL ARTS SCHOOL, 5110 W LOCUST ST, MILWAUKEE, WI 532103

01/25/2017 12/31/2018ST CATHERINE SCHOOL, 2647 N 51ST ST, MILWAUKEE, WI 532103

2945SHECAR SUBSTANCE ABUSE/MENTAL HEALTH OUTPATIENT TREATMENT CENTER, LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201709/01/201706/27/2011

(414) 372-3964

(414) [email protected] R RAMOS

County: MilwaukeeMILWAUKEE, WI 532122821 N 4TH STREET, #120

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 09/01/2017 09/30/2017

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 09/30/2017

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 09/30/2017

Services

NO BRANCH LOCATIONS

3199SIXTEENTH STREET COMMUNITY HEALTH CENTERS - LAYTON

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201804/01/2018

(414) 383-5597

(414) [email protected] ELENA PEREZ, PHD

County: MilwaukeeMILWAUKEE, WI 532214570 S 27TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 04/01/2018 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 93 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3201SMILE INC MENTAL HEALTH AND AODA OUTPATIENT CLINIC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/02/201804/02/2018

(414) 249-3312

(262) [email protected] VEASEY

County: MilwaukeeMILWAUKEE, WI 532164222 W CAPITOL DR #308

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 04/02/2018 03/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/02/2018 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/02/2018 03/31/2019

Services

NO BRANCH LOCATIONS

2373SOCIAL DEVELOPMENT COMMISSION YOUTH & FAMILY DEVELOPMENT PROGRAM

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202006/01/201804/29/2002

(414) 963-2691

(414) 906-2704

SHEILA SAMPTON

County: MilwaukeeMILWAUKEE, WI 532051730 W NORTH AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 08/31/2018

Services

NO BRANCH LOCATIONS

1322ST. CHARLES YOUTH & FAMILY SERVICES - FAMILY DEVELOPMENT CENTER

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201701/01/1991

(414) 358-5005

(414) [email protected] UNDERWOOD

County: MilwaukeeMILWAUKEE, WI 532184757 N. 76TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2017 01/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2017 01/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2017 01/31/2019ST CHARLES - FAMILY DEVELOPMENT CENTER, 151 S 84TH STREET, MILWAUKEE, WI 532141

2690ST. LUKE'S MEDICAL CENTER OUTPATIENT BEHAVIORAL HEALTH CLINIC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201708/30/2006

(414) 454-6450

(414) [email protected] MONSON-DUPUIS

County: MilwaukeeMILWAUKEE, WI 532152900 W OKLAHOMA AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 94 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2921THE BRIDGE HEALTH CLINICS & RESEARCH CENTERS

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201901/01/201808/19/2010

(414) 255-3451

(414) 831-4500toddcampbell@thebridgehealthclinicTODD CAMPBELL

County: MilwaukeeMILWAUKEE, WI 532185401 N 76TH STREET #100

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 07/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 07/31/2019THE BRIDGE HEALTH CLINICS & RC, INC. - BELOIT RD, 9401 BELOIT RD, SUITE 105, MILWAUKEE, WI

532271

2944THE POWER OF CHANGE INC BEHAVIORAL SERVICES

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201707/01/2011

(414) 374-8181

(414) [email protected] ARMON-BENT

County: MilwaukeeMILWAUKEE, WI 532122821 N 4TH STREET SUITE 131

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

1657UNITED COMMUNITY CENTER

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201605/01/1980

(414) 647-8602

(414) [email protected] A. RUIZ

County: MilwaukeeMILWAUKEE, WI 532041100 S 6TH STREET, 3RD FLOOR

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/01/2016 09/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2016 09/30/2018

Services

NO BRANCH LOCATIONS

2881UNITED COMMUNITY CENTER

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201608/13/2009

(414) 647-8602

(414) [email protected] A. RUIZ

County: MilwaukeeMILWAUKEE, WI 53204604 W SCOTT STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 08/01/2016 07/31/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 08/01/2016 07/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 95 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2351UNITED COMMUNITY CENTER LATINAS UNIDAS

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201702/17/2014

(414) 647-8602

(414) [email protected] A. RUIZ

County: MilwaukeeMILWAUKEE, WI 532041123 SOUTH 6TH STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 04/01/2017 03/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

3167UNITED COMMUNITY CENTER-LATINAS UNIDAS 2

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201804/27/201704/27/2017

(414) 645-0165

(414) [email protected] RUIZ

County: MilwaukeeMILWAUKEE, WI 53204614 W SCOTT STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 04/27/2017 04/30/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/27/2017 04/30/2018

Services

NO BRANCH LOCATIONS

3150WCS-JOSHUA GLOVER RESIDENTIAL REENTRY CENTER

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/20/2017

(414) 239-7853

(414) [email protected] FITZSIMONS

County: MilwaukeeMILWAUKEE, WI 532102404 N 50TH STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

3053WCS-MILWAUKEE COUNTY DAY REPORTING CENTER

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201710/01/2014

(414) 342-8847

(414) [email protected] JUSSILA

County: MilwaukeeMILWAUKEE, WI 532083732 W WISCONSIN AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 96 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2547WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. FRANCIS HOSPITAL

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201710/27/2004

(414) 389-3110

(414) [email protected] HESS

County: MilwaukeeMILWAUKEE, WI 532153237 S 16TH STREET #310

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 11/01/2017 10/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2017 10/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/20/2018 10/31/2019ASCENSION COLUMBIA ST MARYS AIRPORT, 4848 S 6TH ST, MILWAUKEE, WI 532211

11/01/2017 10/31/2019WHEATON FRANCISAN BEHAVIORAL HEALTH - FRANKLIN, 9969 S 27TH STREET, FRANKLIN, WI 53132

1

2548WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. JOSEPH REGIONAL MEDICAL CTR

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201710/27/2004

(414) 874-1177

(414) [email protected] HESS

County: MilwaukeeMILWAUKEE, WI 532105000 W CHAMBERS ST #P210

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

2004WILLOWGLEN ACADEMY OUTPATIENT CLINIC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201608/01/1992

(414) 527-6971

(414) [email protected] KUMMROW

County: MilwaukeeMILWAUKEE, WI 532164065 NORTH 35TH STREET STE # N100

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2016 07/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/01/2016 07/10/2017

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2016 07/10/2017

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2016 07/31/2018WILLOWGLEN ACADEMY - DAY ONE EAST, 6414 W. FOND DU LAC AVE, MILWAUKEE, WI 532181

08/01/2016 07/31/2018WILLOWGLEN ACADEMY - CSP NORTH, 4941 W FOND DU LAC AVE, MILWAUKEE, WI 532162

08/01/2016 07/31/2018WILLOWGLEN ACADEMY, 5555 NORTH 51ST BLVD, MILWAUKEE, WI 532182

08/01/2016 07/31/2018WILLOWGLEN ACADEMY - ARROWHEAD UNION HS, 700 NORTH AVE, HARTLAND, WI 530293

06/26/2018 Page 97 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1955WISCONSIN COMMUNITY SERVICES UNLIMITED POTENTIALS

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201606/01/1986

(414) 226-0351

(414) [email protected] CARROLL

County: MilwaukeeMILWAUKEE, WI 532083732 W WISCONSIN AVE STE 200

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/01/2016 09/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2016 09/30/2018

Services

NO BRANCH LOCATIONS

1993WISCONSIN COMMUNITY SERVICES-COMMUNITY SUPPORT PROGRAM

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201611/01/1995

(414) 334-2191

(414) [email protected] COLLYARD

County: MilwaukeeMILWAUKEE, WI 532083734 W WISCONSIN AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

2509WORD OF HOPE MINISTRIES ATODA PROGRAM

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201803/01/2004

(414) 874-2826

(414) [email protected] FULLER

County: MilwaukeeMILWAUKEE, WI 532102677 N 40TH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2018 02/28/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/28/2019

Services

NO BRANCH LOCATIONS

WAUWATOSA

1033ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, S.C.

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201711/20/1997

(414) 358-7158

(414) [email protected] DREXLER

County: MilwaukeeWAUWATOSA, WI 5322210045 W LISBON AVENUE, #221

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2017 11/30/2019ALTERNATIVES IN PSYCH CONSULT, 6737 W WASHINGTON ST SUITE 1300, WEST ALLIS, WI 532142

06/26/2018 Page 98 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2518AURORA BEHAVIORAL HEALTH CENTER WAUWATOSA

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/31/2004

(414) 454-6450

(414) [email protected] MONSON DUPUIS

County: MilwaukeeWAUWATOSA, WI 532131220 DEWEY AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

1647AURORA PSYCHIATRIC HOSPITAL INC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201609/01/1979

(414) 454-6450

(414) [email protected] SURFUS-LEWISTON

County: MilwaukeeWAUWATOSA, WI 532131220 DEWEY AVENUE BLDG 4

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 08/01/2016 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 07/31/2017

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 08/01/2016 07/31/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2016 07/31/2018

MENTAL HEALTH-INPATIENT DHS 61.71 08/01/2016 07/31/2018

Services

NO BRANCH LOCATIONS

3141AURORA PSYCHIATRIC HOSPITAL INC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201708/01/2016

(414) 454-6450

(414) [email protected] SURFUS LEWISTON

County: MilwaukeeWAUWATOSA, WI 532131220 DEWEY AVENUE BLDG 2

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2017 07/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

3142AURORA PSYCHIATRIC HOSPITAL INC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201708/01/2016

(414) 454-6450

(414) [email protected] SURFUS-LEWISTON

County: MilwaukeeWAUWATOSA, WI 532131220 DEWEY AVENUE BLDG 11

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2017 07/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 99 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1516LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/01/1978

(414) 536-8348

(414) [email protected] L RAYBURN

County: MilwaukeeWAUWATOSA, WI 532223800 N MAYFAIR ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020LCFS-ST JOHN LUTHERAN CHURCH, 4850 S LAKE DRIVE, CUDAHY, WI 531101

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 15 E SAWYER, RICE LAKE, WI 548681

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 168 MOUND STREET, BERLIN, WI 549231

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 210 S ONEIDA ST, GREEN BAY, WI 543031

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 2833 RARITAN, FITCHBURG, WI 537111

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 300 BROADWAY DR, SUN PRAIRIE, WI 535901

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 324 S ANDREWS ST, SHAWANO, WI 541661

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 345 NORTH PINE ST, REEDSBURG, WI 539591

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 717 MEMORIAL DRIVE, CHILTON, WI 530141

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 850 ARMSTRONG ST, PORTAGE, WI 539011

Setting Begin/End DatesNon-Certified School Setting(s)04/01/2018 03/31/2020BEAUTIFUL SAVIOR LUTHERAN SCHOOL, 1205 EAST AVE, WAUKESHA, WI 53186

04/01/2018 03/31/2020GRACE LUTHERAN SCHOOL, N87W16173 KENWOOD BLVD, MENOMONEE FALLS, WI 53051

04/01/2018 03/31/2020OUR REDEEMER LUTHERAN SCHOOL, 10025 W NORTH AVE, WAUWATOSA, WI 53226

04/01/2018 03/31/2020RENAISSANCE LUTHERAN SCHOOL, 1510 VILLA ST, RACINE, WI 53403

04/01/2018 03/31/2020RENAISSANCE LUTHERAN SCHOOL, 6150 TAYLOR AVE, RACINE, WI 53403

04/01/2018 03/31/2020SHERMAN PARK, 88242 GRANVILLE RD, MILWAUKEE, WI 53210

2318WEST GROVE CLINIC

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/22/2001

(414) 810-4845

(414) [email protected] WEST

County: MilwaukeeWAUWATOSA, WI 5322210012 WEST CAPITOL DRIVE #101

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020WEST GROVE CLINIC LLC, 7310 W. WELLS ST., WAUWATOSA, WI 532132

WEST ALLIS

2397AURORA BEHAVIORAL HEALTH CENTER - WEST ALLIS

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201707/12/2002

(414) 454-6450

(414) [email protected] MONSON-DUPUIS

County: MilwaukeeWEST ALLIS, WI 532272424 S 90TH STREET SUITE 502

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2017 04/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 100 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2746IMPACT, ALCOHOL AND OTHER DRUG ABUSE SERVICE, INC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201608/09/2007

(414) 771-4808

(414) [email protected] GUTIERREZ

County: MilwaukeeWEST ALLIS, WI 532146737 W WASHINGTON STREET, #2225

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 08/01/2016 07/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2016 07/31/2018IMPACT, ALCOHOL & OTHER DRUG ABUSE SERVICE, 3970 NORTH OAKLAND AVE, SHOREWOOD, WI

532111

2125MILWAUKEE CENTER FOR INDEPENDENCE DBA WHOLE HEALTH CLINICAL GROUP

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201709/01/1985

(414) 615-0627

(414) [email protected] CHIANELLI

County: MilwaukeeWEST ALLIS, WI 53214932 SOUTH 60TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

3032ROGERS MEMORIAL HOSPITAL

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201705/01/2014

(414) 882-7822

(414) [email protected] SCHULTZ

County: MilwaukeeWEST ALLIS, WI 532272448 SOUTH 102ND ST RM #200

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/01/2017 04/30/2019

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 05/01/2017 04/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2017 04/30/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 05/01/2017 04/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2017 04/30/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2017 04/30/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 05/01/2017 04/30/2019

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 101 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2214ROGERS MEMORIAL HOSPITAL - MILWAUKEE

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2000

(414) 327-6045

(414) [email protected] SCHULTZ

County: MilwaukeeWEST ALLIS, WI 5322711101 W. LINCOLN AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 05/01/2018 04/30/2020

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREAT/CHILDREN 2 W/TELEHEALTH DHS 40.11(2)(B) 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 05/01/2018 04/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

3172STEVANOVIC FAMILY CLINICS

Surveyor: William Rohner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201802/15/201702/15/2017

(414) 546-2909

(414) [email protected] STEVANOVIC

County: MilwaukeeWEST ALLIS, WI 5322711111 W OKLAHOMA AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 02/15/2017 01/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/15/2017 01/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/02/2017 01/31/2018

Services

NO BRANCH LOCATIONS

WEST MILWAUKEE

2236QUALITY ADDICTION MANAGEMENT, INC DBA WEST MILWAUKEE COMPREHENSIVE TREATMENT CTR

Surveyor: Merrilee Follensbee

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201606/19/2000

(414) 672-6026

(414) [email protected] BIZJAK

County: MilwaukeeWEST MILWAUKEE, WI 532141610 MILLER PARKWAY

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 102 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MONROECASHTON

2804SCENIC BLUFFS COMMUNITY HEALTH CENTERS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/28/2008

(608) 654-5120

(608) [email protected] MLSNA

County: MonroeCASHTON, WI 54619238 FRONT STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020SCENIC BLUFFS COMMUNITY HEALTH CENTERS, 200 W. NORTH STREET, NORWALK, WI 546481

07/01/2018 06/30/2020SCENIC BLUFFS COMMUNITY HEALTH CENTERS, 217 N BLACK RIVER ST, RM 4, SPARTA, WI 546561

Setting Begin/End DatesNon-Certified School Setting(s)07/01/2018 06/30/2020CASHTON ELEMENTARY SCHOOL, 436 FRONT STREET, CASHTON, WI 54619

07/01/2018 06/30/2020CASHTON MIDDLE/HIGH SCHOOL, 540 COE STREET, CASHTON, WI 54619

07/01/2018 06/30/2020HIGH POINT CHARTER SCHOOL, 201 E FRANKLIN STREET, SPARTA, WI 54656

07/01/2018 06/30/2020S.A.I.L..S. CHARTER SCHOOL, 201 E FRANKLIN STREET, SPARTA, WI 54656

SPARTA

1654MONROE COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201812/01/201610/01/1975

(608) 269-8935

(608) [email protected] THORSEN

County: MonroeSPARTA, WI 5465614301 HWY B COMM SVS CTR A-19

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 12/01/2016 12/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 12/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/01/2016 12/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 103 of 172

Substance Abuse Program Directory By County, City, and Provider Name

OCONTOOCONTO

1719OCONTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201604/01/1979

(920) 834-6889

(920) [email protected] REIMER

County: OcontoOCONTO, WI 54153501 PARK AVENUE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 09/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

CSAS-PREVENTION DHS 75.04 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018NEW VIEW INDUSTRIES, 164 W PARK STREET, GILLETT, WI 541241

06/26/2018 Page 104 of 172

Substance Abuse Program Directory By County, City, and Provider Name

ONEIDAMINOCQUA

3134FAMILY HEALTH CENTER OF MARSHFIELD, INC, MINOCQUA ALCOHOL & DRUG RECOVERY SVS

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201706/30/2016

(715) 358-1330

(715) [email protected] WEIX

County: OneidaMINOCQUA, WI 545489792 HIGHWAY 70 WEST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

RHINELANDER

1762ASCENSION ST MARY'S KOLLER BEHAVIORAL HEALTH

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201806/01/201606/01/1985

(715) 361-2920

(715) [email protected] SCHIEK

County: OneidaRHINELANDER, WI 545011020 KABEL AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2016 05/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/22/2017 05/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2016 05/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/22/2017 05/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2016 05/31/2018ST MARYS HOSP MINISTRY/KOLLER CRANDON, 400 W GLEN STREET, CRANDON, WI 545201

06/01/2016 05/31/2018ST MARYS HOSP MINISTRY/KOLLER TOMAHAWK, 401 MOHAWK AVE, TOMAHAWK, WI 544871

06/01/2016 05/31/2018ST MARYS HOSP MINISTRY/KOLLER EAGLE RIVER, 930 E WALL STREET, EAGLE RIVER, WI 545212

06/01/2016 05/31/2018ST MARYS HOSP MINISTRY/KOLLER WOODRUFF, 240 MAPLE STREET, WOODRUFF, WI 545682

2977CORNERSTONE PSYCHOLOGICAL ASSOCIATES LLC

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201910/01/201708/14/2012

(715) 420-1202

(715) [email protected] F. MCGUIRE LPC

County: OneidaRHINELANDER, WI 54501315 S ONEIDA AVE SUITE 101

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 105 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3196HARMONY COUNSELING SERVICES LLC DBA TRANSITIONS CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/24/201801/24/2018

(715) 365-6768

(715) [email protected] WEGE

County: OneidaRHINELANDER, WI 5450122 N PELHAM ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/24/2018 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/24/2018 12/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier01/24/2018 12/31/2018NICOLET COLLEGE, 5364 COLLEGE DRIVE, RHINELANDER, WI 545011

01/24/2018 12/31/2018PHELPS, 4451 OLD SCHOOL RD, PHELPS, WI 545543

1469KOINONIA OPTIONS COUNSELING SERVICES LLC

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201610/01/1986

(715) 362-2819

(715) [email protected] DECORAH

County: OneidaRHINELANDER, WI 545011991 WINNEBAGO STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 12/01/2016 11/30/2018

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 12/01/2016 11/30/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 106 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2742OPTIONS COUNSELING SERVICES LLC

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/17/2007

(715) 362-2819

(715) [email protected] DECORAH

County: OneidaRHINELANDER, WI 54501158 SOUTH ANDERSON ST SUITE 1

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020KOINONIA, 1991 WINNEBAGO STREET, RHINELANDER, WI 545011

04/01/2018 03/31/2020CENTRAL ELEMENTARY, 418 NORTH PELHAM STREET, RHINELANDER, WI 545013

04/01/2018 03/31/2020CRANDON ELEMENTARY/ MIDDLE/HIGH SCHOOL, 9750 US HWY 8 WEST, CRANDON, WI 545203

04/01/2018 03/31/2020CRESCENT ELEMENTARY, 3319 BOYCE DRIVE, RHINELANDER, WI 545013

04/01/2018 03/31/2020EAGLE RIVER ELEMENTARY SCHOOL, 1700 PLEASURE ISLAND RD, EAGLE RIVER, WI 545213

04/01/2018 03/31/2020JAMES WILLIAMS MIDDLE SCHOOL, 915 ACACIA LANE, RHINELANDER, WI 545013

04/01/2018 03/31/2020LAND O' LAKES ELEMENTARY, 6485 TOWN HALL ROAD, LAND O LAKES, WI 545403

04/01/2018 03/31/2020NORTH ELEMEMTARY, 506 GRAHAM AVE, ANTIGO, WI 544093

04/01/2018 03/31/2020NORTH LAKELAND SCHOOL DISTRICT, 12686 COUNTY HIGHWAY K, MANITOWISH WATERS, WI 54545

3

04/01/2018 03/31/2020NORTHERN ACHIEVEMENT CENTER, 215 DIVISION STREET, EAGLE RIVER, WI 545213

04/01/2018 03/31/2020NORTHLAND PINES HIGH SCHOOL, 1800 PLEASURE ISLAND ROAD, EAGLE RIVER, WI 545213

04/01/2018 03/31/2020NORTHLAND PINES MIDDLE SCHOOL, 1700 PLEASURE ISLAND RD, EAGLE RIVER, WI 545213

04/01/2018 03/31/2020NORTHWOODS COMM. SECONDARY CHARTER SCHOOL, 665 COOLIDGE AVENUE, RHINELANDER, WI 54501

3

04/01/2018 03/31/2020NORTHWOODS COMMUNITY ELEMENTARY CHARTER SCHOOL, 9086 COUNTY HWY K, HARSHAW, WI 54529

3

04/01/2018 03/31/2020PELICAN ELEMENTARY, 3350 V HICKEY ROAD, RHINELANDER, WI 545013

04/01/2018 03/31/2020RHINELANDER HIGH SCHOOL, 665 COOLIDGE, RHINELANDER, WI 545013

04/01/2018 03/31/2020SOAR CHARTER SCHOOL, 6485 TOWN HALL RD, LAND O LAKES, WI 545403

04/01/2018 03/31/2020ST GERMAIN ELEMENTARY SCHOOL, 8234 HWY 70 WEST, SAINT GERMAIN, WI 545583

1427THE HUMAN SERVICE CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201609/01/1980

(715) 369-2214

(715) [email protected] SHIMECK

County: OneidaRHINELANDER, WI 54501705 EAST TIMBER DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2016 09/30/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/01/2016 09/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2016 09/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 10/01/2016 09/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 107 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3043THE HUMAN SERVICE CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/27/2014

(715) 369-2214

(715) [email protected] SHIMECK

County: OneidaRHINELANDER, WI 54501705 EAST TIMBER DRIVE

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL UNIFIED BOARD DHS 36 07/01/2018 06/30/2020

CCS REGIONAL MODEL UNIFIED BOARD W/TELEHEALTH DHS 36 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

1426THE HUMAN SERVICE CENTER CSP

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201809/01/1980

(715) 369-2214

(715) [email protected] SHIMECK

County: OneidaRHINELANDER, WI 54501705 E. TIMBER DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 06/01/2018 05/31/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2018 05/31/2019

Services

NO BRANCH LOCATIONS

2642TRANSITIONS CENTER, LLC

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201804/01/201702/01/2006

(715) 365-6768

(715) [email protected] MARTIN

County: OneidaRHINELANDER, WI 5450122 N PELHAM STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 01/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2017 01/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier05/30/2017 01/31/2018TRANSITIONS NICOLET, RED OAK CENTER - ROOM 207A NICOLET COLLEGE, RHINELANDER, WI

545011

06/26/2018 Page 108 of 172

Substance Abuse Program Directory By County, City, and Provider Name

OUTAGAMIEAPPLETON

2608ACS CLINICAL SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201609/01/2005

(920) 830-1770

(920) [email protected] MANN

County: OutagamieAPPLETON, WI 54912720 W WASHINGTON STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018ACS CLINICAL SERVICES - MANITOWOC, 33 E WALDO BLVD, MANITOWOC, WI 542202

3017ACS CLINICAL SERVICES, LLC - APPLETON CRP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/16/2015

(920) 840-6445

(920) [email protected] MANN

County: OutagamieAPPLETON, WI 549152 BRIGHTON CIRCLE

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

1130CASA CLARE, A DIVISION OF MOORING PROGRAMS, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201703/21/1996

(920) 731-2853

(920) [email protected] VERVOORT

County: OutagamieAPPLETON, WI 54914201 S GLENRIDGE COURT

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 04/01/2017 03/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 03/31/2019

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 04/01/2017 03/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 109 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2984CATALPA HEALTH INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201711/01/2012

(920) 882-5495

(920) [email protected] RADKE

County: OutagamieAPPLETON, WI 54914444 NORTH WESTHILL BLVD

Service Begin/End DatesAdm Code

CSAS-PREVENTION DHS 75.04 11/01/2017 10/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2017 10/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2017 10/31/2019BOYS AND GIRLS CLUB OF OSHKOSH, 501 E PARKWAY AVENUE, OSHKOSH, WI 549011

11/01/2017 10/31/2019CATALPA HEALTH - CASALOMA CAMPUS, 1920 N CASALOMA ST, APPLETON, WI 549132

11/01/2017 10/31/2019CATALPA HEALTH - WAUPACA, 825 WEST FULTON ST, WAUPACA, WI 549812

11/01/2017 10/31/2019CATALPA HEALTH ACCESS CENTER, 442 WESTHILL BLVD., APPLETON, WI 549142

11/01/2017 10/31/2019CATALPA HEALTH, 540 N KOELLER ST, OSHKOSH, WI 549022

11/01/2017 10/31/2019BLACK CREEK ELEMENTARY & MIDDLE SCHOOLS, 308 EAST BURDICK ST, BLACK CREEK, WI 541063

11/01/2017 10/31/2019CHILTON HIGH SCHOOL, 530 W MAIN ST, CHILTON, WI 530143

11/01/2017 10/31/2019CLAYTON ELEMENTARY SCHOOL, 2916 WEST FAIRVIEW ROAD, NEENAH, WI 549563

11/01/2017 10/31/2019COOLIDGE ELEMENTARY SCHOOL, 321 ALCOTT DRIVE, NEENAH, WI 549563

11/01/2017 10/31/2019FREEDOM ELEMENTARY SCHOOL, N3569 COUNTY ROAD E, FREEDOM, WI 541313

11/01/2017 10/31/2019FREEDOM HIGH & MIDDLE SCHOOLS, N4021 COUNTY ROAD E, FREEDOM, WI 541313

11/01/2017 10/31/2019GREENVILLE ELEMENTARY SCHOOL, W6822 GREENRIDGE DR., GREENVILLE, WI 549423

11/01/2017 10/31/2019GREENVILLE MIDDLE SCHOOL, N1450 FAWN RIDGE DR., GREENVILLE, WI 549423

11/01/2017 10/31/2019HOOVER ELEMENTARY SCHOOL, 950 HUNT AVENUE, NEENAH, WI 549563

11/01/2017 10/31/2019HORIZON ELEMENTARY SCHOOL, 2101 SCHAEFER CIRCLE, APPLETON, WI 549153

11/01/2017 10/31/2019HORTONVILLE ELEMENTARY SCHOOL, 240 WARNER ST., HORTONVILLE, WI 549443

11/01/2017 10/31/2019HORTONVILLE HIGH SCHOOL, 155 WARNER ST; PO BOX 220, HORTONVILLE, WI 549443

11/01/2017 10/31/2019HORTONVILLE MIDDLE SCHOOL, 220 WARNER ST; PO BOX 359, HORTONVILLE, WI 549443

11/01/2017 10/31/2019LAKEVIEW ELEMENTARY SCHOOL, 1645 S. COMMERCIAL ST., NEENAH, WI 549563

11/01/2017 10/31/2019MADISON MIDDLE SCHOOL, 2020 S. CARPENTER STREET, APPLETON, WI 549153

11/01/2017 10/31/2019MENASHA HIGH SCHOOL, 420 SEVENTH STREET, MENASHA, WI 549523

11/01/2017 10/31/2019MERRILL MIDDLE SCHOOL, 108 W NEW YORK AVE, OSHKOSH, WI 549013

11/01/2017 10/31/2019NORTH GREENVILLE ELEMENTARY SCHOOL, N2468 LEARNING WAY, GREENVILLE, WI 549423

11/01/2017 10/31/2019OSHKOSH NORTH HIGH SCHOOL, 1100 W. SMITH AVE., OSHKOSH, WI 549013

11/01/2017 10/31/2019OSHKOSH NORTH HIGH SCHOOL, 375 N EAGLE ST, OSHKOSH, WI 549023

11/01/2017 10/31/2019READ ELEMENTARY SCHOOL, 1120 ALGOMA BLVD, OSHKOSH, WI 549013

11/01/2017 10/31/2019ROCKLEDGE PRIMARY/INTERMEDIATE CENTERS, 330 WEST HICKORY ST, SEYMOUR, WI 541653

11/01/2017 10/31/2019ROOSEVELT ELEMENTARY SCHOOL, 1645 S COMMERCIAL STREET, NEENAH, WI 549563

11/01/2017 10/31/2019ROOSEVELT MIDDLE SCHOOL, 318 EAST BREWSTER ST, APPLETON, WI 549113

11/01/2017 10/31/2019SHIOCTON PUBLIC SCHOOLS, N5650 BROAD ST, SHIOCTON, WI 541703

11/01/2017 10/31/2019SPRING ROAD ELEMENTARY SCHOOL, 1191 COUNTY ROAD II, NEENAH, WI 549563

11/01/2017 10/31/2019TAFT ELEMENTARY SCHOOL, 133 WESTERN AVENUE, NEENAH, WI 549563

11/01/2017 10/31/2019TULLAR ELEMENTARY SCHOOL, 925 TULLAR ROAD, NEENAH, WI 549563

11/01/2017 10/31/2019WASHINGTON ELEMENTARY SCHOOL, 929 WINNEBAGO AVE, OSHKOSH, WI 549013

11/01/2017 10/31/2019WAUPACA HIGH SCHOOL, E2325 KING ROAD, WAUPACA, WI 549813

11/01/2017 10/31/2019WAUPACA LEARNING CENTER ELEMENTARY SCHOOL, 1515 SHOEMAKER ROAD, WAUPACA, WI 54981

3

11/01/2017 10/31/2019WAUPACA MIDDLE SCHOOL, 1149 SHOEMAKER ROAD, WAUPACA, WI 549813

11/01/2017 10/31/2019WEBSTER STANLEY MIDDLE SCHOOL, 915 HAZEL STREET, OSHKOSH, WI 549013

11/01/2017 10/31/2019WILSON ELEMENTARY SCHOOL, 920 HIGGINS AVENUE, NEENAH, WI 549563

06/26/2018 Page 110 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2872LUTHERAN SOCIAL SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201706/02/2009

(920) 734-2824

(920) [email protected] MITCHELL

County: OutagamieAPPLETON, WI 549113003 B NORTH RICHMOND ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2017 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2017 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2018LUTHERAN SOCIAL SERVICES, 1850 CRANSTON ROAD, BELOIT, WI 535111

09/01/2017 08/31/2018LUTHERAN SOCIAL SERVICES, 612 N RANDALL STREET, JANESVILLE, WI 535452

09/01/2017 08/31/2018LUTHERAN SOCIAL SERVICES, 6314 ODANA ROAD, MADISON, WI 537192

Setting Begin/End DatesNon-Certified School Setting(s)09/01/2017 08/31/2018LSS-APPLETON EAST HIGH SCHOOL, 2121 E EMMERS DR, APPLETON, WI 54915

09/01/2017 08/31/2018LSS-CLOVIS GROVE ELEMENTARY SCHOOL, 974 NINTH STREET, MENASHA, WI 54952

09/01/2017 08/31/2018LSS-FRANKLIN ELEMENTARY SCHOOL, 800 S 35TH STREET, MANITOWOC, WI 54220

09/01/2017 08/31/2018LSS-HEAD START-CAPITOL, 5310 W CAPITOL DR, MILWAUKEE, WI 53216

09/01/2017 08/31/2018LSS-IDEAS ACADEMY, 830 VIRGINIA AVE, SHEBOYGAN, WI 53081

09/01/2017 08/31/2018LSS-LB CLARKE MIDDLE SCHOOL, 4608 BELLEVUE PLACE, TWO RIVERS, WI 54241

09/01/2017 08/31/2018LSS-PLYMOUTH HIGH SCHOOL, 125 S HIGHLAND AVE, PLYMOUTH, WI 53073

09/01/2017 08/31/2018LSS-RANDOM LAKE ELEMENTARY SCHOOL, 605 RANDOM LAKE ROAD, RANDOM LAKE, WI 53075

1962MILWAUKEE HEALTH SERVICES SYSTEM, LLC DBA APPLETON COMPREHENSIVE TREATMENT CTR

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201607/09/1990

(920) 733-4796

(920) [email protected] WILLIQUETTE

County: OutagamieAPPLETON, WI 549113301 N BALLARD RD SUITE B

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

1917MOORING PROGRAMS, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201805/08/1991

(920) 731-4796

(920) [email protected] VERVOORT

County: OutagamieAPPLETON, WI 54911607 W. SEVENTH STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2018 06/30/2020

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 07/01/2018 06/30/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 111 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2512OPTIONS TREATMENT PROGRAMS INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2004

(920) 735-9010

(920) [email protected] HAGEN

County: OutagamieAPPLETON, WI 549141000 N LYNNDALE DRIVE STE C

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020OPTIONS TREATMENT PROGRAMS, INC., 424 S MONROE AVE #201, GREEN BAY, WI 543012

04/01/2018 03/31/2020OPTIONS TREATMENT PROGRAMS, INC., 922 CHURCHILL ST, WAUPACA, WI 549812

04/01/2018 03/31/2020OPTIONS TREATMENT PROGRAMS-OSHKOSH, 502 E. NEW YORK AVE., OSHKOSH, WI 549012

2314OUTAGAMIE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1987

(920) 832-5488

(920) [email protected] MARMOR

County: OutagamieAPPLETON, WI 54911320 S WALNUT ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

2590OUTAGAMIE CTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201704/01/2005

(920) 832-5488

(920) [email protected] VAN RYZIN

County: OutagamieAPPLETON, WI 54911401 S ELM STREET

CCS Affiliaton: 09/01/2014Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

1860ST. ELIZABETH HOSPITAL

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201702/01/1984

(920) 730-5480

(920) [email protected] REICH

County: OutagamieAPPLETON, WI 549151506 S. ONEIDA STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 11/01/2017 10/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2017 10/31/2019

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 11/01/2017 10/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 112 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1997WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC DBA CHRISTIAN FAMILY SOLUTIONS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201605/01/1990

(262) 345-5531

(262) [email protected] SEMMANN

County: OutagamieAPPLETON, WI 549144351 WEST COLLEGE AVE #410

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2016 08/31/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/13/2017 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018WLCFS - CHRISTIAN FAMILY SOLUTIONS, 757 S MAIN ST, STE 8, FOND DU LAC, WI 549352

09/01/2016 08/31/2018FOX VALLEY LUTHERAN HS, 5300 N MEADE ST, APPLETON, WI 549133

09/01/2016 08/31/2018NORTHLAND LUTHERAN HS, 2107 TOWER ROAD, MOSINEE, WI 544553

09/01/2016 08/31/2018WINNEBAGO LUTHERAN ACADEMY, 475 E MERRILL AVE, FOND DU LAC, WI 549353

06/26/2018 Page 113 of 172

Substance Abuse Program Directory By County, City, and Provider Name

OZAUKEECEDARBURG

1695NORTHSHORE CLINIC & CONSULTANTS, INC.

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201710/01/1987

(262) 375-1071

(262) [email protected] MYERS

County: OzaukeeCEDARBURG, WI 53012W62 N248 WASHINGTON AVE., #207

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 11/30/2017

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2017 07/31/2019NORTHSHORE CLINIC & CONSULTANTS, 207 E BUFFALO STREET, #510, MILWAUKEE, WI 532021

08/01/2017 07/31/2019NORTHSHORE CLINIC & CONSULTANTS, 2363 S 102ND STREET, #203, WEST ALLIS, WI 532272

08/01/2017 07/31/2019NORTHSHORE CLINIC & CONSULTANTS, INC., 1615 BARTON AVENUE, WEST BEND, WI 530902

GRAFTON

3009ALARUS HEALTHCARE, LLC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201610/08/2013

(262) 377-6289

(262) [email protected] J. OWEN

County: OzaukeeGRAFTON, WI 530241971 WASHINGTON ST SUITE 200

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/01/2016 09/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2016 09/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2016 09/30/2018ALARUS HEALTHCARE - BEAVER DAM, 111 WARREN ST #2, BEAVER DAM, WI 539162

10/01/2016 09/30/2018ALARUS HEALTHCARE - WEST BEND, 1622 CHESTNUT ST., WEST BEND, WI 530952

MEQUON

3176ACHIEVEMENT ASSOCIATES CENTER INC

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201709/01/2017

(262) 241-5054

(262) [email protected] FREEMAN

County: OzaukeeMEQUON, WI 530921317 TOWNE SQUARE RD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2017 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2017 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2018ACHIEVEMENT ASSOCIATES CENTER INC, 2600 N MAYFAIR ROAD, MILWAUKEE, WI 532262

09/01/2017 08/31/2018ACHIEVEMENT ASSOCIATES CENTER INC, 5228 W FOND DU LAC AVE, MILWAUKEE, WI 532162

06/26/2018 Page 114 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2368AMERICAN BEHAVIORAL CLINICS

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202007/01/201805/01/2002

(262) 241-4311

(262) [email protected] SCHRINSKY

County: OzaukeeMEQUON, WI 530921240 W RANCHITO LANE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 05/31/2020AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #2, 9720 W BLUEMOUND ROAD, MILWAUKEE, WI

532261

07/01/2018 05/31/2020AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #1, 10424 W BLUEMOUND ROAD, MILWAUKEE, WI 53226

2

07/01/2018 05/31/2020AMERICAN BEHAVIORAL CLINICS-ELM GROVE, 15285 WATERTOWN PLANK ROAD, ELM GROVE, WI 53122

2

07/01/2018 05/31/2020AMERICAN BEHAVIORAL CLINICS-LAYTON, 7330 W LAYTON AVENUE, MILWAUKEE, WI 532202

2507COLUMBIA ST MARY'S BEHAVIORAL MEDICINE-MEQUON

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201809/02/2003

(262) 241-6132

(262) [email protected] MCGLYNN

County: OzaukeeMEQUON, WI 5309713111 N PORT WASHINGTON ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

1873COLUMBIA ST. MARY'S OZAUKEE HOSPITAL BEHAVIORAL HEALTH UNIT

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201809/01/1984

(262) 243-8380

(414) [email protected] MCGLYNN

County: OzaukeeMEQUON, WI 5309713111 N PORT WASHINGTON RD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2018 02/29/2020

MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

PORT WASHINGTON

1276DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201606/01/1977

(262) 238-8104

(262) [email protected] CARLSON

County: OzaukeePORT WASHINGTON, WI 53074121 W. MAIN STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/01/2016 09/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2016 09/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2016 09/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 115 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2274DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY CSP

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201706/01/1977

(262) 238-8104

(262) [email protected] DRAKE

County: OzaukeePORT WASHINGTON, WI 53074121 W. MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

3050OZAUKEE COUNTY CCS PROGRAM

Surveyor: Demetrius Anderson

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201609/22/2014

(262) 284-8104

(262) [email protected] CARLSON

County: OzaukeePORT WASHINGTON, WI 53074121 W MAIN STREET

CCS Affiliaton: 01/01/2015Begin: End: Lead:Lakeshore Recovery Collaborative

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 10/01/2016 09/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 116 of 172

Substance Abuse Program Directory By County, City, and Provider Name

PIERCEELLSWORTH

1737PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201712/01/1981

(715) 273-6862

(715) [email protected] KIESLER

County: PierceELLSWORTH, WI 54011412 W KINNE STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

3020PIERCE COUNTY DEPT OF HUMAN SVS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201704/01/2014

(715) 273-6862

(715) [email protected] KIESLER

County: PierceELLSWORTH, WI 54011412 WEST KINNE STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

RIVER FALLS

1468KINNIC FALLS ALCOHOL AND DRUG ABUSE SERVICES INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201705/01/1990

(715) 426-5763

(715) [email protected] IHUS

County: PierceRIVER FALLS, WI 54022900 S ORANGE STREET

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 117 of 172

Substance Abuse Program Directory By County, City, and Provider Name

POLKAMERY

2839AMERY REGIONAL MEDICAL CENTER BEHAVIORAL HEALTH CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201712/08/2008

(715) 268-0061

(715) 268-0060Heather.E.Erickson@AmerymedicalHEATHER ERICKSON

County: PolkAMERY, WI 54001230 DERONDA STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/04/2018 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2017 11/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2017 11/30/2019CLEAR LAKE CLINIC, 357 THIRD AVENUE, CLEAR LAKE, WI 540051

01/08/2018 11/30/2019LUCK CLINIC, AMERY HOSPITAL AND CLINIC, 2547 SATE ROAD 35, SUITE 1, LUCK, WI 548531

12/01/2017 11/30/2019TURTLE LAKE CLINIC, 550 MARTIN AVENUE, TURTLE LAKE, WI 548891

BALSAM LAKE

2222POLK COUNTY BEHAVIORAL HEALTH DEPARTMENT CSP

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201801/26/2000

(715) 485-8450

(715) [email protected] LAVASSEUR

County: PolkBALSAM LAKE, WI 54810100 POLK CO PLAZA #50

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

2204POLK COUNTY BEHAVIORAL HEALTH DEPT

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201802/08/2000

(715) 485-8490

(715) [email protected] LAVASSEUR

County: PolkBALSAM LAKE, WI 54810100 POLK COUNTY PLAZA #50

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 118 of 172

Substance Abuse Program Directory By County, City, and Provider Name

PORTAGEPLOVER

2566OSWALD COUNSELING ASSOCIATES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201801/14/2005

(715) 342-0291

(715) [email protected] OSWALD

County: PortagePLOVER, WI 544672450 VINEYARD DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2020

Services

NO BRANCH LOCATIONS

STEVENS POINT

1216ASCENSION ST MICHAELS BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201909/01/201710/01/1990

(715) 345-0223

(715) [email protected] ROBERTS

County: PortageSTEVENS POINT, WI 54481201 PRENTICE STREET NORTH

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 09/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

1217ASCENSION ST MICHAELS BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201909/01/201705/01/1991

(715) 344-8127

(715) [email protected] ROBERTS

County: PortageSTEVENS POINT, WI 54481209 PRENTICE STREET NORTH

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 06/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 06/30/2019ASCENSION ST MICHAELS BEHAVIORAL HEALTH, 190 GRAND SEASONS DR, WAUPACA, WI 549812

1820ASCENSION ST MICHAELS BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201705/01/1978

(715) 346-5571

(715) [email protected] ROBERTS

County: PortageSTEVENS POINT, WI 54481900 ILLINOIS AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2017 09/30/2019

MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 119 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1740PORTAGE COUNTY HEALTH & HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201706/01/1976

(715) 345-5966

(715) [email protected] MARCOTT

County: PortageSTEVENS POINT, WI 54481817 WHITING AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 03/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2017 03/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

2712PORTAGE COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/2007

(715) 345-5966

(715) [email protected] MARCOTT

County: PortageSTEVENS POINT, WI 54481817 WHITING AVENUE

CCS Affiliaton: 09/01/2014Begin: End: Lead:Portage Wood Partnership

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

2230RIVERWOOD COUNSELING ASSOCIATES LLC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/17/2000

(715) 343-5899

(715) [email protected] A MILLER

County: PortageSTEVENS POINT, WI 544811052 MAIN STREET, #202

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 120 of 172

Substance Abuse Program Directory By County, City, and Provider Name

PRICEPHILLIPS

1244COUNSELING AND DEVELOPMENT CENTER, INC.

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201708/01/1982

(715) 339-2436

(715) [email protected] ENGFER

County: PricePHILLIPS, WI 54555171 CHESTNUT STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2017 07/31/2018COUNSELING & DEVELOPMENT CENTER, 170 N 4TH AVE, PARK FALLS, WI 545521

2053COUNSELING AND DEVELOPMENT CENTER, INC. COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201711/01/201508/01/1998

(715) 339-2436

(715) [email protected] ENGFER

County: PricePHILLIPS, WI 54555171 CHESTNUT STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 11/01/2015 10/31/2017

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2015 10/31/2017

Services

NO BRANCH LOCATIONS

3131NEW HORIZONS NORTH COMMUNITY SUPPORT PROGRAM PRICE COUNTY

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201704/28/2016

(715) 682-7176

(715) [email protected] LEVNO

County: PricePHILLIPS, WI 545551215 N AIRPORT RD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 121 of 172

Substance Abuse Program Directory By County, City, and Provider Name

RACINEBURLINGTON

1022AGAPE RECOVERY CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201704/01/1994

(262) 767-9072

(262) [email protected] A GRAMKE

County: RacineBURLINGTON, WI 53105201 N PINE ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

RACINE

2976BEHAVIORAL HEALTH SERVICES OF RACINE COUNTY

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201708/02/2012

(262) 638-6540

(262) [email protected] GOGGINS

County: RacineRACINE, WI 534031717 TAYLOR AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 11/17/2017 07/31/2019

CSAS-PREVENTION DHS 75.04 08/01/2017 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/17/2017 07/31/2019

Services

NO BRANCH LOCATIONS

1339FAMILY SERVICE OF RACINE, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201711/01/1983

(262) 634-5342

(262) [email protected] HANSON WILL

County: RacineRACINE, WI 53403420 SEVENTH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/10/2017 04/20/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

2730GBS LAUREL HOUSE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/25/201804/09/2007

(262) 633-5626

(414) [email protected] SANCHEZ

County: RacineRACINE, WI 534041725 SPRING PLACE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 05/25/2018 04/30/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/25/2018 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 122 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2777GENESIS BEHAVIORAL SERVICES, INC. CHATHAM HOUSE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/2008

(262) 637-2620

(414) [email protected] SANCHEZ

County: RacineRACINE, WI 534021636 CHATHAM STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 03/01/2017 02/28/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

1380GENESIS BEHAVIORAL SERVICES, INC. CROSSROADS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201709/01/1994

(262) 633-5626

(414) [email protected] SANCHEZ

County: RacineRACINE, WI 534024107-4109 ST CLAIR STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 09/01/2017 08/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

2341QUALITY ADDICTION MANAGEMENT, INC DBA RACINE COMPREHENSIVE TREATMENT CTR

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201611/12/2001

(262) 598-1395

(262) [email protected] RODRIGUEZ

County: RacineRACINE, WI 534065735 DURAND AVENUE

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

3031RACINE COUNTY CCS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201705/08/2014

(262) 638-6857

(262) [email protected] GOGGINS

County: RacineRACINE, WI 534031717 TAYLOR AVE

CCS Affiliaton: 12/01/2014Begin: End: Lead:Kenosha Racine Regional Consortium (KRRC)

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 06/01/2017 05/31/2019

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 11/17/2017 05/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 123 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2490RACINE COUNTY HUMAN SERVICES DEPARTMENT

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/14/2004

(262) 638-6983

(262) [email protected] GOGGINS

County: RacineRACINE, WI 534031717 TAYLOR AVENUE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 01/01/2017 12/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

2952RACINE COUNTY HUMAN SERVICES DEPARTMENT COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201612/01/2011

(262) 638-6983

(262) [email protected] GOGGINS

County: RacineRACINE, WI 534031717 TAYLOR AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

1027WHEATON FRANCISCAN HEALTHCARE ALL SAINTS MENTAL HEALTH & ADDICTION CARE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1990

(262) 687-2802

(262) [email protected] NIELSEN

County: RacineRACINE, WI 534031320 WISCONSIN AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 07/01/2018 06/30/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2018 06/30/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 07/01/2018 06/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS, 2408 FOUR MILE ROAD, RACINE, WI 534022

07/01/2018 06/30/2020WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS, 3805B SPRING ST #240, RACINE, WI 534022

07/01/2018 06/30/2020WHEATON FRANCISCAN HEALTHCARE-SPRING STREET CAMPUS, 3821 SPRING ST, RACINE, WI 53405

2

07/01/2018 06/30/2020WHEATON FRANCISCAN HLTHCARE ALL SAINTS STURTEVANT, 10340 WASHINGTON AVENUE, STURTEVANT, WI 53177

2

07/01/2018 06/30/2020WHEATON FRANCISCAN MED GRP - FAMILY MED CLINIC, 3807 SPRING ST #3063A, RACINE, WI 53405

2

07/01/2018 06/30/2020WHEATON FRANCISCAN MED GRP-CENTER FOR ADDICTION, 3805 B SPRING ST LL-20, RACINE, WI 53403

2

07/01/2018 06/30/2020WHEATON FRANCISCAN MEDICAL GROUP - NEUROLOGY, 3805 B SPRING ST 3RD FLOOR, RACINE, WI 53405

2

07/01/2018 06/30/2020WHEATON FRANCISCAN MEDICAL GROUP - UNION GROVE, 1120 MAIN ST, UNION GROVE, WI 531822

07/01/2018 06/30/2020WHEATON FRANCISCAN MEDICAL GROUP, 8020 S HOWELL AVE, OAK CREEK, WI 531542

07/01/2018 06/30/2020WHEATON FRANCISCAN MEDICAL GROUP-ALL SAINTS, 4328 OLD GREEN BAY ROAD, MOUNT PLEASANT, WI 53403

2

06/26/2018 Page 124 of 172

Substance Abuse Program Directory By County, City, and Provider Name

RICHLANDRICHLAND CENTER

1797RICHLAND COUNTY HEALTH & HUMAN SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/01/1988

(608) 647-6611

(608) [email protected] CULVER

County: RichlandRICHLAND CENTER, WI 53581221 W SEMINARY STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 02/01/2018 01/31/2020

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 02/01/2018 01/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 01/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 02/01/2018 01/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 02/01/2018 01/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

2563RICHLAND COUNTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/01/2005

(608) 647-6611

(608) [email protected] CULVER

County: RichlandRICHLAND CENTER, WI 53581221 W SEMINARY STREET

CCS Affiliaton: 07/01/2014Begin: End: Lead:Wisconsin River CCS Collaboration

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 125 of 172

Substance Abuse Program Directory By County, City, and Provider Name

ROCKBELOIT

1100BELOIT MEMORIAL HOSPITAL-COUNSELING CARE CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201607/01/1985

(608) 363-5756

(608) [email protected] NEECE

County: RockBELOIT, WI 535111969 W HART ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2016 11/30/2018BELOIT HEALTH SYSTEM, CANCER CENTER, 1670 LEE LANE, BELOIT, WI 535111

12/01/2016 11/30/2018JANESVILLE OCCUPATIONAL HEALTH, 1409 B CRESTON PARK MALL DRIVE, JANESVILLE, WI 535451

12/01/2016 11/30/2018BELOIT MEMORIAL HIGH SCHOOL, 1225 4TH STREET, BELOIT, WI 535113

2686QUALITY ADDICTION MANAGEMENT, INC DBA BELOIT COMPREHENSIVE TREATMENT CTR

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201610/06/2006

(608) 361-7201

(608) [email protected] RHODES

County: RockBELOIT, WI 535112240 PRAIRIE AVENUE #10

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

1804ROCK COUNTY HUMAN SERVICES DEPARTMENT - BELOIT COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201709/01/1989

(608) 363-6392

(608) [email protected] COTTINGTON

County: RockBELOIT, WI 5351164 ECLIPSE CENTER

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

JANESVILLE

1809COMPASS BEHAVIORAL HEALTH CLINIC, A DIVISION OF RVCP

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/1990

(608) 741-4502

(608) [email protected] EGGERS

County: RockJANESVILLE, WI 53546203 W SUNNY LANE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020COMPASS JANESVILLE CLINIC, 1820 CENTER AVE #170, JANESVILLE, WI 535462

06/26/2018 Page 126 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1381GENESIS COUNSELING SERVICES LTD

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1988

(608) 757-2319

(608) [email protected] BURNS

County: RockJANESVILLE, WI 53545ONE S MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3126JANESVILLE MOBILIZING 4 CHANGE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201911/01/201706/08/2016

(608) 741-2105janesvillemobilizing4change@gmailERIN DAVIS

County: RockJANESVILLE, WI 53545ONE PARKER PLACE, STE 308

Service Begin/End DatesAdm Code

CSAS-PREVENTION DHS 75.04 11/01/2017 05/31/2019

Services

NO BRANCH LOCATIONS

3002MERCY HEALTH SYSTEM - MERCY OPTIONS WINGS PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201705/18/2013

(608) 756-6564

(608) [email protected] USGAARD

County: RockJANESVILLE, WI 53548903 MINERAL POINT AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2017 06/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

1612MERCY OPTIONS - MERCY HEALTH SYSTEMS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201710/01/1984

(608) 756-6564

(608) [email protected] USGAARD

County: RockJANESVILLE, WI 535481000 MINERAL POINT AVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2017 06/30/2019

MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 127 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1610MERCY OPTIONS BEHAVIORAL HEALTH CLINIC JANESVILLE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/01/1993

(608) 756-0174

(608) [email protected] USGAARD

County: RockJANESVILLE, WI 53548903 MINERAL POINT ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019MERCY MALL CLINIC, 1010 N WASHINGTON, JANESVILLE, WI 535451

01/01/2018 12/31/2019MERCY CLINIC NORTH, 3400 DEERFIELD DRIVE, JANESVILLE, WI 535461

01/01/2018 12/31/2019MERCY EAST CLINIC, 3524 E MILWAUKEE STREET, JANESVILLE, WI 535461

01/01/2018 12/31/2019MERCY OPTIONS BEHAVIORAL HEALTH CLINIC - MILTON, 725 S. JANESVILLE ST, MILTON, WI 535631

01/01/2018 12/31/2019MERCY OPTIONS-OUTPATIENT SERVICES, 507 W MAIN ST, WHITEWATER, WI 531901

01/01/2018 12/31/2019MERCY WEST CLINIC, 1000 MINERAL POINT ROAD, JANESVILLE, WI 535451

01/01/2018 12/31/2019MERCY BELOIT CLINIC, 2825 PRAIRIE AVENUE, BELOIT, WI 535112

01/01/2018 12/31/2019MERCY EVANSVILLE CLINIC, 300 UNION STREET, EVANSVILLE, WI 535362

01/01/2018 12/31/2019MERCY OPTIONS BEHAVIORAL HEALTH CLINIC - MERCYCARE, 580 N. WASHINGTON ST., JANESVILLE, WI 53548

2

01/01/2018 12/31/2019MERCY OPTIONS BH CLINIC - WALWORTH, N2846 STATE ROAD 67, WILLIAMS BAY, WI 531912

2741MERCY OPTIONS CHILD AND ADOLESCENT DAY TREATMENT

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/01/2007

(608) 758-5761

(608) [email protected] USGAARD

County: RockJANESVILLE, WI 535452600 HUMES RD, SUITE 100

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2017 06/30/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

3030ROCK COUNTY COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2014

(608) 757-5545

(608) [email protected] SINGER

County: RockJANESVILLE, WI 535461900 CENTER AVE

CCS Affiliaton: 08/01/2014Begin: End: Lead:JRW Tri County Regional CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 128 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1807ROCK COUNTY COUNSELING CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201610/01/1975

(608) 757-5545

(608) [email protected] LAKE

County: RockJANESVILLE, WI 53548113 S FRANKLIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018ROCK COUTNY JOB CENTER, 1900 CENTER AVENUE, JANESVILLE, WI 535461

09/01/2016 08/31/2018COURT STREET BRANCH OFFICE, 303 W. COURT ST., JANESVILLE, WI 535482

09/01/2016 08/31/2018ROCK CNTY CNSLNG CTR - BELOIT BRANCH, 64 ECLIPSE CENTER, BELOIT, WI 535112

09/01/2016 08/31/2018ROCK CNTY CNSLNG CTR - HEALTHCARE CTR BRANCH, 3530 N COUNTY TRK HWY F, JANESVILLE, WI 53547

2

1805ROCK COUNTY HUMAN SERVICES DEPT JANESVILLE COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201709/01/1989

(608) 757-5545

(608) [email protected] COTTINGTON

County: RockJANESVILLE, WI 53548113 S FRANKLIN ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

1265TRIVIUM DBA CROSSROADS COUNSELING CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201709/01/1977

(608) 755-5267

(608) [email protected] PERRY

County: RockJANESVILLE, WI 5354817 S RIVER STREET #254

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 10/01/2017 09/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2017 09/30/2019CROSSROADS COUNSELING CENTER, 778 LOIS DRIVE, SUN PRAIRIE, WI 535901

06/26/2018 Page 129 of 172

Substance Abuse Program Directory By County, City, and Provider Name

RUSKLADYSMITH

2948ACCESS, INC COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201709/06/2011

(715) 532-9774

(715) [email protected] WOLF

County: RuskLADYSMITH, WI 54848108 W 2ND STREET N

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 09/01/2017 08/31/2019

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 130 of 172

Substance Abuse Program Directory By County, City, and Provider Name

SAINT CROIXHUDSON

1118BURKWOOD TREATMENT CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201803/01/1988

(715) 381-0158

(715) [email protected] BROOKS

County: Saint CroixHUDSON, WI 54016615 OLD MILL ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/01/2018 04/30/2020

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

1173HUDSON HOSPITAL & CLINICS, PROGRAMS FOR CHANGE

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201709/01/1990

(715) 531-6766

(715) 531-6755Peter.J.Vandusartz@HudsonHospitPETER VAN DUSARTZ

County: Saint CroixHUDSON, WI 54016405 STAGELINE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2017 11/30/2019HUDSON HOSPITAL AND CLINIC, 411 STAGELINE ROAD, HUDSON, WI 540161

NEW RICHMOND

3110ST. CROIX COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES - CCS

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2016

(715) 246-8284

(715) [email protected] KIRT

County: Saint CroixNEW RICHMOND, WI 540171752 DORSET LANE

CCS Affiliaton: 04/01/2016Begin: End: Lead:Eau Claire and St. Croix CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2018 03/31/2020

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

1856ST. CROIX COUNTY HEALTH & HUMAN SERVICES - BEHAVIORAL HEALTH

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201601/01/1990

(715) 246-8461

(715) [email protected] KIRT

County: Saint CroixNEW RICHMOND, WI 540171752 DORSET LANE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 06/01/2017 11/30/2018

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 131 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1855ST. CROIX COUNTY HEALTH & HUMAN SERVICES BEHAVIORAL HEALTH

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201610/01/1975

(715) 246-8284

(715) [email protected] KIRT

County: Saint CroixNEW RICHMOND, WI 540171752 DORSET LANE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 06/01/2017 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 06/01/2017 11/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/01/2016 11/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 06/01/2017 11/30/2018

Services

NO BRANCH LOCATIONS

3161WESTFIELDS HOSPITAL

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201712/01/2016

(715) 243-2851

(715) [email protected] BARTLETT

County: Saint CroixNEW RICHMOND, WI 54017535 HOSPITAL ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 132 of 172

Substance Abuse Program Directory By County, City, and Provider Name

SAINT LOUISDULUTH

2064CENTER FOR ALCOHOL & DRUG TREATMENT DETOX

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201709/01/1998

(218) 529-3440

(218) [email protected] ANDERSON

County: Saint LouisDULUTH, MN 558051402 E. SUPERIOR STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 133 of 172

Substance Abuse Program Directory By County, City, and Provider Name

SAUKBARABOO

2713SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/2007

(608) 355-4299

(608) [email protected] BOESL

County: SaukBARABOO, WI 53913505 BROADWAY

CCS Affiliaton: 07/01/2014Begin: End: Lead:Wisconsin River CCS Collaboration

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2017 02/28/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2017 02/28/2019SAUK COUNTY DEPT HUMAN SERVICES REEDSBURG, 425 - 6TH STREET, REEDSBURG, WI 539591

1824SAUK COUNTY DEPARMENT OF HUMAN SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/01/1988

(608) 355-4299

(608) [email protected] MIJAL

County: SaukBARABOO, WI 53913505 BROADWAY STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 01/01/2018 12/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2018 12/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019SAUK COUNTY DHS - REEDSBURG OFFICE, 425 SIXTH STREET, REEDSBURG, WI 539591

2087SSM HEALTH TREATMENT & RECOVERY CENTER

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201811/25/1998

(608) 356-1365

(608) [email protected] LOHMAN

County: SaukBARABOO, WI 539131510 JEFFERSON STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 02/01/2018 01/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

2586ST. CLARE HOSPITAL & HEALTH SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201807/01/2004

(608) 356-1367

(608) [email protected] SCHWARTZ

County: SaukBARABOO, WI 53913707 - 14TH STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 134 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3127TELLURIAN OUTPATIENT SERVICES

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201706/01/2016

(608) 222-6694

(608) [email protected] CROOKS

County: SaukBARABOO, WI 53913414 BROADWAY ST SUITE 101

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 11/01/2017 05/31/2019

CSAS-INTERVENTION DHS 75.16 06/01/2017 05/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2017 05/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2017 05/31/2019

Services

NO BRANCH LOCATIONS

PRAIRIE DU SAC

3138PATHWAY TO WELLNESS COMMUNITY CLINIC, LLC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/01/2016

(608) [email protected] KIRCH

County: SaukPRAIRIE DU SAC, WI 53578560 4TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/20/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2017 06/30/2019

Services

Setting Begin/End DatesNon-Certified School Setting(s)07/01/2017 06/30/2019SAUK PRAIRIE HIGH SCHOOL, 105 NINTH ST, PRAIRIE DU SAC, WI 53578

REEDSBURG

2774GOODMAN'S BEHAVIORAL HEALTH CLINIC LLC

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/06/2008

(608) 768-4646

(608) [email protected] GOODMAN

County: SaukREEDSBURG, WI 539592213 E MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

1823SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Central Office

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1990

(608) 524-7980

(608) [email protected] CIBULKA

County: SaukREEDSBURG, WI 53959425 SIXTH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 135 of 172

Substance Abuse Program Directory By County, City, and Provider Name

SAWYERHAYWARD

1486LAC COURTE ORIELLES BEHAVIORAL HEALTH

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201803/01/1987

(715) 634-6107

(715) [email protected] BERGUM

County: SawyerHAYWARD, WI 5484313447 W COUNTY HIGHWAY B SUITE 1

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 06/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2019LAC COURTE OREILLES OJIBWE SCHOOL, 8575 N. TREPANIA ROAD, HAYWARD, WI 548433

3160LCO CCS

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201805/01/2017

(715) 634-6107

(715) [email protected] BERGUM

County: SawyerHAYWARD, WI 5484313447 W COUNTY B, SUITE 2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 05/01/2018 04/30/2019

Services

NO BRANCH LOCATIONS

2330NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201602/01/2001

(715) 634-2533

(715) [email protected] LUND

County: SawyerHAYWARD, WI 5484310270 OLKER ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

3166NORTHWOODS BEHAVIORAL HEALTH SERVICES LLC

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201803/01/201703/01/2017

(715) 634-4765

(715) 634-4673dcousins@northwoodsbehavioralheDANIEL COUSINS SR.

County: SawyerHAYWARD, WI 5484315617-B US HWY 63N

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 136 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1825SAWYER COUNTY HEALTH & HUMAN SERVICES/INFORMATION & REFERRAL CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201804/01/1979

(715) 634-3580

(715) [email protected] CARLSON

County: SawyerHAYWARD, WI 5484310610 MAIN ST SUITE 224

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-PREVENTION DHS 75.04 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020TRANSITION HOUSE, 16208 WOOD RIDGE LANE, HAYWARD, WI 548431

06/26/2018 Page 137 of 172

Substance Abuse Program Directory By County, City, and Provider Name

SHAWANOBOWLER

1882STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201606/19/2014

(715) 793-1312

(715) [email protected] MOHAWK

County: ShawanoBOWLER, WI 54416W12802 COUNTY HWY A

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2016 07/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 07/31/2018

Services

NO BRANCH LOCATIONS

GRESHAM

1554MAEHNOWESEKIYAH WELLNESS CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201711/21/1989

(715) 799-3836

(715) [email protected] ANN DICK

County: ShawanoGRESHAM, WI 54128N2150 KESAEHKAHTEK

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2017 11/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

CSAS-PREVENTION DHS 75.04 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

SHAWANO

1831SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201703/01/1977

(715) 526-5542

(715) [email protected] FROST

County: ShawanoSHAWANO, WI 54166504 LAKELAND ROAD

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 01/01/2017 12/31/2018

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 01/01/2017 12/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2017 12/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 01/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2017 12/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 01/01/2017 12/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2017 12/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 138 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2242SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/01/2000

(715) 526-5542

(715) [email protected] THOUSAND

County: ShawanoSHAWANO, WI 54166504 LAKELAND ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 63 01/01/2017 12/31/2018

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

2863SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER CCS

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201705/06/2014

(715) 526-5542

(715) [email protected] THOUSAND

County: ShawanoSHAWANO, WI 54166504 LAKELAND ROAD

CCS Affiliaton: 12/01/2014Begin: End: Lead:Lakeshore Recovery Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2017 06/30/2019

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

1832THEDACARE MEDICAL CENTER - SHAWANO

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201810/01/1978

(715) 526-7205

(715) [email protected] BLOCK

County: ShawanoSHAWANO, WI 54166100 COUNTY ROAD B

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 139 of 172

Substance Abuse Program Directory By County, City, and Provider Name

SHEBOYGANPLYMOUTH

2677LIFE POINT COUNSELING, LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201607/06/2006

(920) 449-4247

(920) [email protected] NIVER

County: SheboyganPLYMOUTH, WI 53073433A EAST MILL STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2016 07/31/2018

Services

NO BRANCH LOCATIONS

SHEBOYGAN

1925AURORA SHEBOYGAN CLINIC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201808/01/201607/01/1986

(920) 459-1483

(920) [email protected] LEE-JOHNSON

County: SheboyganSHEBOYGAN, WI 530812414 KOHLER MEMORIAL DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2016 06/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2016 06/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier04/12/2018 06/30/2018AURORA BEHAVIORAL HEALTH WELLNESS CENTER, 1221 N 26TH ST, SHEBOYGAN, WI 530811

08/01/2016 06/30/2018AURORA SHEBOYGAN CLINIC, 2600 KILEY WAY, PLYMOUTH, WI 530731

1835AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/1987

(920) 451-5123

(920) [email protected] KNITT

County: SheboyganSHEBOYGAN, WI 530832629 N 7TH STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 05/01/2018 04/30/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 05/01/2018 04/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

3171AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER-AURORA BEHAVIORAL HEALTH CENTER

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201812/26/2016

(920) 451-5123

(920) [email protected] KNITT

County: SheboyganSHEBOYGAN, WI 530811221 N 26TH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/01/2018 04/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 140 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2869LEPAK JOSTSONS INC DBA DYNAMIC FAMILY SOLUTIONS

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201608/19/2009

(920) 358-5970

(920) [email protected] A LEPAK JOSTSONS

County: SheboyganSHEBOYGAN, WI 53081615 SOUTH 8TH ST SUITE 220

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/14/2018 08/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 05/29/2018 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/29/2018 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018DYNAMIC FAMILY SOLUTIONS - STURGEON BAY, 101 NORTH 4TH AVENUE, STURGEON BAY, WI

542352

09/01/2016 08/31/2018DYNAMIC FAMILY SOLUTIONS, 3021 HOLMGREN WAY, GREEN BAY, WI 543052

09/01/2016 08/31/2018DYNAMIC FAMILY SOLUTIONS, ONE WALDO BLVD SUITE 3, MANITOWOC, WI 542202

1656NETT-WORK FAMILY COUNSELING, LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/27/1998

(920) 458-6439

(920) [email protected] L. NETT

County: SheboyganSHEBOYGAN, WI 530832801 CALUMET DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020NETT-WORK FAMILY COUNSELING LLC, 1011 - 10TH STREET #1, MANITOWOC, WI 542201

03/01/2018 02/29/2020NETT-WORK FAMILY COUNSELING LLC, 1403 MILWAUKEE DR, NEW HOLSTEIN, WI 530611

03/01/2018 02/29/2020NETT-WORK FAMILY COUNSELING LLC, 621 E MILL ST, PLYMOUTH, WI 530731

03/01/2018 02/29/2020NETT-WORK FAMILY COUNSELING, LLC, 3321 SOUTH 12TH ST, SHEBOYGAN, WI 530812

1699NORTHSHORE CLINIC LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201808/01/1991

(920) 457-8867

(920) [email protected] DIELENTHEIS

County: SheboyganSHEBOYGAN, WI 53081805 NORTH 6TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Setting Begin/End DatesNon-Certified School Setting(s)03/01/2018 02/29/2020JEFFERSON ELEMENTARY SCHOOL, 1538 N 15TH ST, SHEBOYGAN, WI 53081

06/26/2018 Page 141 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2931QUALITY ADDICTION MANAGEMENT, INC DBA SHEBOYGAN COMPREHENSIVE TREATMENT CTR

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201601/03/2011

(920) 458-6623

(920) [email protected] OKOROMA

County: SheboyganSHEBOYGAN, WI 530812842 S BUSINESS DRIVE

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier08/10/2017 08/31/2018QAM, INC DBA SHEBOYGAN CTC, 2902 S BUSINESS DRIVE, SHEBOYGAN, WI 530812

3194SHEBOYGAN CO HEALTH AND HUMAN SERVICES CSP

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201901/29/201801/29/2018

(920) 459-6459

(920) [email protected] KREPSKY

County: SheboyganSHEBOYGAN, WI 530811011 N 8TH ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/29/2018 01/31/2019

Services

NO BRANCH LOCATIONS

1834SHEBOYGAN COUNTY DEPT OF HEALTH AND HUMAN SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201810/01/201607/01/1986

(920) 459-4353

(920) [email protected] A GALLAWAY

County: SheboyganSHEBOYGAN, WI 530811011 N 8TH STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/01/2016 09/30/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2016 09/30/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/01/2016 09/30/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2016 09/30/2018

Services

NO BRANCH LOCATIONS

2667SHEBOYGAN COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201805/01/2006

(920) 459-4353

(920) [email protected] KREPSKY

County: SheboyganSHEBOYGAN, WI 530811011 N 8TH STREET

CCS Affiliaton: 01/01/2015Begin: End: Lead:Lakeshore Recovery Collaborative

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 142 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3070ST. NICHOLAS HOSPITAL DBA PREVEA HEALTH

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201710/27/2014

(920) 272-1201

(920) [email protected] STUMBRAS

County: SheboyganSHEBOYGAN, WI 530813425 SUPERIOR AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2017 11/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2017 11/30/2019PREVEA HEALTH KOHLER, 950 WOODLAKE RD, KOHLER, WI 530441

12/01/2017 11/30/2019PREVEA PLYMOUTH HEALTH CENTER, 825 WALTON DRIVE, PLYMOUTH, WI 530731

WALDO

3156PATHWAYS DETOX LLC

Surveyor: Erin Taylor

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/27/2017

(920) 894-1373

(920) [email protected] COOPER

County: SheboyganWALDO, WI 530931102 W 1ST STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 03/01/2018 02/29/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 143 of 172

Substance Abuse Program Directory By County, City, and Provider Name

TAYLORMEDFORD

2753COUNSELING CONNECTION OF MEDFORD

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201609/01/2007

(715) 748-4407

(715) [email protected] SCHULTZ

County: TaylorMEDFORD, WI 54451123 WEST STATE STREET #4

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018PHOENIX HOUSE, 600 W. HICKORY STREET, GILMAN, WI 544331

09/25/2017 08/31/2018MEDFORD ADULT DIPLOMA ACADEMY & ALT ED PROGRAM, 624 E COLLEGE ST, MEDFORD, WI 54451

3

09/01/2016 08/31/2018MEDFORD ELEMENTARY SCHOOL-COUNSELING CONNECTION, 1065 W BROADWAY AVE, MEDFORD, WI 54451

3

09/01/2016 08/31/2018MEDFORD HIGH SCHOOL-COUNSELING CONNECTION, 1015 W BROADWAY AVE, MEDFORD, WI 54451

3

09/01/2016 08/31/2018MEDFORD MIDDLE SCHOOL-COUNSELING CONNECTION, 509 CLARK ST, MEDFORD, WI 544513

09/25/2017 08/31/2018STETSONVILLE ELEMENTARY SCHOOL, W5338 COUNTY RD A, STETSONVILLE, WI 544803

3169NORTH CENTRAL REGION CCS PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201802/01/201702/01/2017

(715) 748-3342

(715) [email protected] KETELHUT

County: TaylorMEDFORD, WI 54451540 E COLLEGE STREET

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 02/01/2017 01/31/2018

CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 36 02/01/2017 01/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2017 01/31/2018IRON CO HUMAN SERVICES & ASSOCIATES, 300 TACONITE ST #201, HURLEY, WI 545341

3193NORTH CENTRAL REGION CCS PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201801/01/2018

(715) 748-3342

(715) [email protected] KETELHUT

County: TaylorMEDFORD, WI 54451540 E COLLEGE STREET

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 01/01/2018 12/31/2018

CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 36 01/01/2018 12/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2018IRON COUNTY HUMAN SERVICES & ASSOC, 300 TACONITE STREET, STE 201, HURLEY, WI 545341

01/01/2018 12/31/2018PRICE COUNTY HEALTH AND HUMAN SVS, 104 SOUTH EYDER, PHILLIPS, WI 545551

01/01/2018 12/31/2018SAWYER COUNTY HEALTH AND HUMAN SVS, 10610 MAIN STREET, STE 224, HAYWARD, WI 548431

06/26/2018 Page 144 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1898TAYLOR COUNTY HUMAN SERVICES DEPARTMENT

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/01/1982

(715) 748-3342

(715) [email protected] MEYER

County: TaylorMEDFORD, WI 54451540 E. COLLEGE STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 145 of 172

Substance Abuse Program Directory By County, City, and Provider Name

TREMPEALEAUINDEPENDENCE

2543WEST CENTRAL WISCONSIN BEHAVIORAL HEALTH CLINIC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201709/03/2004

(715) 985-3029

(715) [email protected] PYKA

County: TrempealeauINDEPENDENCE, WI 5474723062 WHITEHALL RD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

WHITEHALL

3170TREMPEALEAU COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201803/01/2017

(715) 538-4274

(715) [email protected] SUCHLA

County: TrempealeauWHITEHALL, WI 5477336245 MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2018 02/28/2019

Services

NO BRANCH LOCATIONS

3094TREMPEALEAU COUNTY HUMAN SERVICES - CCS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201609/01/2015

(715) 538-4174

(715) [email protected] SUCHLA

County: TrempealeauWHITEHALL, WI 5477336245 MAIN ST

CCS Affiliaton: 09/01/2015Begin: End: Lead:CCS of Clark and Trempealeau Counties

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2016 08/31/2018

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 146 of 172

Substance Abuse Program Directory By County, City, and Provider Name

VERNONVIROQUA

1317FAMILY AND CHILDREN'S CENTER, INC. COMMUNITY SUPPORT PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201701/01/1996

(608) 637-8500

(608) [email protected] HOWE

County: VernonVIROQUA, WI 546651321 N MAIN ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

3092STRIVE COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201808/01/201608/01/2015

(608) 637-5505

(608) [email protected] EITLAND

County: VernonVIROQUA, WI 54665318 FAIRLANE DRIVE SUITE 100

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 08/01/2016 07/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2016 07/31/2018CRAWFORD CO DEPT. OF HUMAN SERVICES, 225 N. BEAUMONT RD SUITE 326, PRAIRIE DU CHIEN,

WI 538212

1963VERNON MEMORIAL HOSPITAL

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201602/01/1978

(608) 637-2141

(608) [email protected] FINLEY

County: VernonVIROQUA, WI 54665507 S. MAIN STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 147 of 172

Substance Abuse Program Directory By County, City, and Provider Name

VILASLAC DU FLAMBEAU

1325FAMILY RESOURCE CENTER

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201709/01/1988

(715) 588-3903

(715) [email protected] SAMUELSON

County: VilasLAC DU FLAMBEAU, WI 54538533 PEACE PIPE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2018DOMESTIC ABUSE PROGRAM, 157 CEDAR AVENUE, LAC DU FLAMBEAU, WI 545381

09/01/2017 08/31/2018SOBER HOME - MEN'S, 1219 ARNOLD STOCK ROAD, LAC DU FLAMBEAU, WI 545381

09/01/2017 08/31/2018SOBER HOME - WOMEN'S, 2355 BOBIDOSH POINT LANE, LAC DU FLAMBEAU, WI 545381

09/01/2017 08/31/2018LAC DU FLAMBEAU PUBLIC SCHOOL, 2899 HWY 47, LAC DU FLAMBEAU, WI 545383

09/01/2017 08/31/2018LAKELAND UNION HIGH SCHOOL, 9573 STATE HWY 70, MINOCQUA, WI 545483

3100GOOKOMIS ENDAAD

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201803/01/201801/19/2016

(715) 588-1889

(715) [email protected] THOMPSON

County: VilasLAC DU FLAMBEAU, WI 545383378 N SCHILLEMAN RD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 04/30/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2018 04/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 04/30/2018

Services

NO BRANCH LOCATIONS

3071LAC DU FLAMBEAU HEALTH & HUMAN SERVICES CCS

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201805/01/201702/01/2015

(715) 588-3855

(715) [email protected] THUNDER

County: VilasLAC DU FLAMBEAU, WI 54538418 LITTLE PINES ROAD

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 05/01/2017 01/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 148 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WALWORTHELKHORN

1262CREDENCE THERAPY ASSOCIATES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201612/19/1995

(262) 723-8308

(262) [email protected] STEEN

County: WalworthELKHORN, WI 531211-1/2 W. GENEVA STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2016 11/30/2018BADGER HIGH SCHOOL, 220 E. SOUTH STREET, LAKE GENEVA, WI 531473

12/01/2016 11/30/2018BIG FOOT HIGH SCHOOL, 401 DEVILS LANE PO BOX 89, WALWORTH, WI 531843

12/01/2016 11/30/2018DELAVAN-DARIEN HIGH SCHOOL, 150 CUMMINGS ST, DELAVAN, WI 531153

12/01/2016 11/30/2018ELKHORN AREA HIGH SCHOOL, 482 EAST GENEVA STREET, ELKHORN, WI 531213

12/01/2016 11/30/2018ELKHORN AREA MIDDLE SCHOOL, 627 EAST COURT ST., ELKHORN, WI 531213

12/01/2016 11/30/2018JACKSON ELEMENTARY SCHOOL, 13 NORTH JACKSON STREET, ELKHORN, WI 531213

12/01/2016 11/30/2018LAKE GENEVA MIDDLE SCHOOL, 600 BLOOMFIELD ROAD, LAKE GENEVA, WI 531473

12/01/2016 11/30/2018PHOENIX MIDDLE SCHOOL, 414 BELOIT ST, DELAVAN, WI 531153

12/01/2016 11/30/2018TIBBETS ELEMENTARY SCHOOL, W5218 COUNTY ROAD A, ELKHORN, WI 531213

12/01/2016 11/30/2018WEST SIDE ELEMENTARY SCHOOL, 222 SUNSET DRIVE, ELKHORN, WI 531213

2694WALWORTH COUNTY DEPT OF HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201711/08/2006

(262) 741-3217

(262) [email protected] KADLEC

County: WalworthELKHORN, WI 53121W4051 COUNTY ROAD NN

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

2889WALWORTH COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201701/20/2010

(262) 741-3217

(262) [email protected] KADLEC

County: WalworthELKHORN, WI 53121W4051 COUNTY ROAD NN

CCS Affiliaton: 08/01/2014Begin: End: Lead:JRW Tri County Regional CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 149 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1967WALWORTH COUNTY HEALTH AND HUMAN SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201610/01/1975

(262) 741-3217

(262) [email protected] NEVICOSI

County: WalworthELKHORN, WI 53121W4051 COUNTY TRUNK NN

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 06/08/2017 08/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 150 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WASHBURNSHELL LAKE

2926WASHBURN COUNTY COMMUNITY SUPPORT PROGRAM

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201711/01/2010

(715) 468-1588

(715) [email protected] SCHRANKEL

County: WashburnSHELL LAKE, WI 54871600 E COUNTY ROAD B

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

SPOONER

2631ACCESS, INC.

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/01/2006

(715) 635-4861

(715) [email protected] WOLF

County: WashburnSPOONER, WI 548014851 HWY 63 SOUTH

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 1302 ARLEN CT, EAU CLAIRE, WI 547031

01/01/2018 12/31/2019ACCESS, INC, 330 E LASALLE STREET, BARRON, WI 548121

01/01/2018 12/31/2019ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 345 FRENETTE DRIVE, SUITE 3, CHIPPEWA FALLS, WI 54729

1

01/01/2018 12/31/2019ACCESS, INC - LADYSMITH, 108 W. 2ND STREET N, LADYSMITH, WI 548482

01/01/2018 12/31/2019ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 406 TECHNOLOGY DR. E SUITE C, MENOMONIE, WI 54751

2

01/01/2018 12/31/2019ACCESS, INC. - SIREN, 24248 STATE HWY 35/70, UNIT D, SIREN, WI 548722

01/01/2018 12/31/2019ACCESS INC-LADYSMITH ELEMENTARY SCHOOL, 624 EAST 6TH STREET, LADYSMITH, WI 548483

01/01/2018 12/31/2019ACCESS, INC - SPOONER MIDDLE SCHOOL, 750 OAK STREET, SPOONER, WI 548013

01/01/2018 12/31/2019ACCESS, INC - CADOTT HIGH SCHOOL, 426 MYRTLE STREET, CADOTT, WI 547273

01/01/2018 12/31/2019ACCESS, INC. - SPOONER ELEMENTARY SCHOOL, 1821 SCRIBNER STREET, SPOONER, WI 548013

01/01/2018 12/31/2019ACCESS, INC. - SPOONER HIGH SCHOOL, 801 COUNTY HWY A, SPOONER, WI 548013

01/01/2018 12/31/2019ACCESS, INC-LADYSMITH MIDDLE SCHOOL, 115 E 6TH STREET SOUTH, LADYSMITH, WI 548483

01/01/2018 12/31/2019ACCESS, INC-SCHOOL DISTRICT OF FLAMBEAU, N 4540 CTY HWY I, TONY, WI 545633

01/01/2018 12/31/2019GRANTSBURG MIDDLE/SENIOR HIGH SCHOOL, 480 EAST JAMES AVENUE, GRANTSBURG, WI 548403

3198WHOLE LIFE SERVICES

Surveyor: Polly Wong

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/23/201804/23/2018

(715) 645-0336

(715) [email protected] EHRICH

County: WashburnSPOONER, WI 54801819 ASH STREET STE SO2O

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/23/2018 03/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 151 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WASHINGTONJACKSON

1243ELEVATE, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/1990

(262) 677-2124

(262) [email protected] SIMON

County: WashingtonJACKSON, WI 53037N169 W21005 MEADOW LANE

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 03/01/2017 02/28/2019

CSAS-PREVENTION DHS 75.04 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

KEWASKUM

2598EXODUS TRANSITIONAL CARE FACILITY, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201801/01/2005

(262) 626-8431

(262) [email protected] COLWIN

County: WashingtonKEWASKUM, WI 530401421 FOND DU LAC AVENUE

Service Begin/End DatesAdm Code

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

SLINGER

3102MILLENIUM MANNOR, LLC D/B/A THE MANOR (4509)

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201611/24/2015

(847) 510-0662

(414) [email protected] HOLLANDER

County: WashingtonSLINGER, WI 530864509 ARTHUR ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

3103MILLENIUM MANOR, LLC D/B/A THE MANOR (4505)

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201708/10/2016

(847) 510-0662

(847) [email protected] HOLLANDER

County: WashingtonSLINGER, WI 530864505 ARTHUR ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 152 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WEST BEND

1017AFFILIATED CLINICAL SERVICES INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201810/01/1984

(262) 338-9767

(262) [email protected] FEUCHT

County: WashingtonWEST BEND, WI 53095111 E WASHINGTON STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020AFFILIATED CLINICAL SERVICES INC, 38 SELL DRIVE #B, HARTFORD, WI 530272

Setting Begin/End DatesNon-Certified School Setting(s)07/01/2018 06/30/2020BADGER MIDDLE SCHOOL, 727 S 6TH AVE, ROOM #112, WEST BEND, WI 53095

07/01/2018 06/30/2020WEST BEND EAST & WEST HIGH SCHOOL, 1305 E DECORAH RD, RM N 15, WEST BEND, WI 53095

2851AFFILIATED CLINICAL SERVICES INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201803/01/2009

(262) 338-9767

(262) [email protected] FEUCHT

County: WashingtonWEST BEND, WI 53095111 EAST WASHINGTON STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2018 02/28/2019

Services

NO BRANCH LOCATIONS

2641CALM HARBOR

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201702/01/2006

(262) 677-2124

(262) [email protected] HARPER

County: WashingtonWEST BEND, WI 53095141 SOUTH 8TH AVE

Service Begin/End DatesAdm Code

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 03/01/2017 02/28/2019

Services

NO BRANCH LOCATIONS

2303WASHINGTON COUNTY MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201810/01/1975

(262) 335-6827

(262) [email protected] HAUPT

County: WashingtonWEST BEND, WI 53095333 E. WASHINGTON ST SUITE 2100

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2018 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 153 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2580WASHINGTON COUNTY MENTAL HEALTH CENTER COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2005

(262) 335-6827

(262) [email protected] MOGLOWSKY

County: WashingtonWEST BEND, WI 53095333 E WASHINGTON STREET, #2100

CCS Affiliaton: 01/01/2015Begin: End: Lead:Lakeshore Recovery Collaborative

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 154 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WAUKESHABROOKFIELD

1237CORNERSTONE COUNSELING SERVICES, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/1993

(262) 821-6180

(262) [email protected] TEUTEBERG

County: WaukeshaBROOKFIELD, WI 5300516535 W. BLUEMOUND ROAD, #200

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC, 5007 S HOWELL AVENUE, SUITE 350, MILWAUKEE,

WI 532072

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 10850 W PARK PLACE, #100, MILWAUKEE, WI 532242

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 11649 N PORT WASHINGTON RD, #201, MEQUON, WI 53092

2

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 1230 CORPORATE CENTER DR, STE 100, OCONOMOWOC, WI 53066

2

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 400 BAY VIEW ROAD, SUITE C, MUKWONAGO, WI 53149

2

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 4811 S 76TH ST #208, GREENFIELD, WI 532202

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 5555 N PORT WASHINGTON ROAD, #200, GLENDALE, WI 53217

2

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 741 N GRAND AVENUE, #302, WAUKESHA, WI 531862

3122HEALING CORNER, LLC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201705/02/2016

(262) 373-0148

(262) [email protected] POVLETICH

County: WaukeshaBROOKFIELD, WI 5304519115 W CAPITOL DRIVE, SUITE 117

Service Begin/End DatesAdm Code

CSAS-AMBULATORY DETOXIFICATION DHS 75.08 07/27/2017 04/30/2019

CSAS-DAY TREATMENT DHS 75.12 05/01/2017 04/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

2654WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. JOSEPH HOSPITAL II

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201707/22/2005

(414) 874-6291

(414) [email protected] HESS

County: WaukeshaBROOKFIELD, WI 5300513950 W CAPITOL DR 2ND FLOOR

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2019ELMBROOK MEMORIAL HOSPITAL, 19333 W MORTH AVE #304, BROOKFIELD, WI 530451

06/26/2018 Page 155 of 172

Substance Abuse Program Directory By County, City, and Provider Name

ELM GROVE

3189RED OAK COUNSELING LTD

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/05/201803/05/2018

(262) 780-1022

(262) [email protected] GUENTHER

County: WaukeshaELM GROVE, WI 5312212970 WEST BLUEMOUND RD #200

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/05/2018 02/28/2019

Services

NO BRANCH LOCATIONS

HARTLAND

2134ALLIANCE COUNSELING CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201708/06/1999

(262) 781-3672

(262) [email protected] BINDER

County: WaukeshaHARTLAND, WI 53029155 E CAPITOL DRIVE, SUITE 6A

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2017 01/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2017 01/31/2019ALLIANCE COUNSELING CENTER, 2312 N GRANDVIEW BOULEVARD, #103, WAUKESHA, WI 531881

02/01/2017 01/31/2019ALLIANCE COUNSELING CENTER, N91 W17194 APPLETON AVE, #105, MENOMONEE FALLS, WI 53051

1

3136YOUR CHOICE TO LIVE INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201710/05/2016

(262) 367-0110

(262) [email protected] NOWAKOWSKI

County: WaukeshaHARTLAND, WI 53029138 NORTH AVENUE

Service Begin/End DatesAdm Code

CSAS-PREVENTION DHS 75.04 12/01/2017 11/30/2019

Services

NO BRANCH LOCATIONS

MENOMONEE FALLS

2076FROEDTERT & THE MEDICAL COLLEGE OF WI-COMMUNITY MEMORIAL HOSPITAL

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201610/01/1982

(262) 257-2570

(262) [email protected] BENSON

County: WaukeshaMENOMONEE FALLS, WI 53051W180 N8085 TOWN HALL ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 156 of 172

Substance Abuse Program Directory By County, City, and Provider Name

MUSKEGO

3162AURORA PSYCHIATRIC HOSPITAL MUSKEGO PROGRAMS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201812/14/2016

(414) 422-2190

(414) [email protected] SURFUS-LEWISTON

County: WaukeshaMUSKEGO, WI 53150S74W16775 JANESVILLE ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2018 12/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

OCONOMOWOC

1810ROGERS MEMORIAL HOSPITAL

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201708/01/1988

(262) 646-3158

(262) [email protected] SCHULTZ

County: WaukeshaOCONOMOWOC, WI 5306634700 VALLEY ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 11/01/2017 10/31/2019

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 11/01/2017 10/31/2019

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 11/01/2017 10/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

2070ROGERS MEMORIAL HOSPITAL - HERRINGTON RECOVERY CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201706/01/1998

(262) 646-3158

(262) [email protected] SCHULTZ

County: WaukeshaOCONOMOWOC, WI 5306634700 VALLEY ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 06/01/2017 05/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 157 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3099ROGERS MEMORIAL HOSPITAL - SILVER LAKE OUTPATIENT CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201609/28/2015

(262) 646-1049

(262) [email protected] SCHULTZ

County: WaukeshaOCONOMOWOC, WI 530661205 CORPORATE CENTER DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 11/01/2016 10/31/2018

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 11/01/2016 10/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2016 10/31/2018

MENTAL HEALTH-DAY TREAT/CHILDREN 2 W/TELEHEALTH DHS 40.11(2)(B) 11/01/2016 10/31/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 11/01/2016 10/31/2018

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 11/01/2016 10/31/2018

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

PEWAUKEE

2798LAKE COUNTRY WELLNESS AND COUNSELING

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201608/13/2008

(262) 691-4966

(262) [email protected] GARRISON, PHD

County: WaukeshaPEWAUKEE, WI 53072285 FOREST GROVE DRIVE, #210

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

2987ROSECRANCE INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/16/2013

(815) 316-4638

(815) [email protected] DEROSSO

County: WaukeshaPEWAUKEE, WI 53072N27 W23957 PAUL ROAD STE 101

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 158 of 172

Substance Abuse Program Directory By County, City, and Provider Name

SUSSEX

1768QUAD/MED, LLC, SUBSTANCE ABUSE COUNSELING SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201912/01/201712/01/1995

(414) 566-8038

(414) [email protected] KELSEY

County: WaukeshaSUSSEX, WI 53089W227 N6103 SUSSEX ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2017 11/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2017 11/30/2019QUAD/GRAPHICS, 1900 W SUMNER STREET, HARTFORD, WI 530271

12/01/2017 11/30/2019QUAD/GRAPHICS, 555 S 108TH STREET, WEST ALLIS, WI 532141

12/01/2017 11/30/2019QUAD/GRAPHICS, N11896 HWY 175, PO BOX 2718, LOMIRA, WI 530481

12/01/2017 11/30/2019QUAD/GRAPHICS, N63 W23075 HWY 74, SUSSEX, WI 530891

WAUKESHA

2258ADDICTION RESOURCE COUNCIL, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201707/26/2000

(262) 524-7932

(262) [email protected] A. MUCHKA

County: WaukeshaWAUKESHA, WI 53186741 N GRAND AVE, SUITE 200

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 07/01/2017 06/30/2019

CSAS-PREVENTION DHS 75.04 07/01/2017 06/30/2019

Services

NO BRANCH LOCATIONS

2386AURORA BEHAVIORAL HEALTH CENTER - WAUKESHA

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/01/2002

(414) 454-6450

(414) [email protected] MONSON-DUPUIS

County: WaukeshaWAUKESHA, WI 53186W231 N1440 CORPORATE CT #310

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020AURORA BEHAVIORAL HEALTH CENTER-MENOMONEE FALLS, W84W16889 MENOMONEE AVE,

MENOMONEE FALLS, WI 530511

05/01/2018 04/30/2020AURORA BEHAVIORAL HEALTH CENTER-BROOKFIELD, 16985 WEST BLUEMOUND ROAD, BROOKFIELD, WI 53005

2

05/01/2018 04/30/2020AURORA BEHAVIORAL HEALTH CENTER-NEW BERLIN, 14555 W NATIONAL AVE, NEW BERLIN, WI 53151

2

05/01/2018 04/30/2020AURORA BEHAVIORAL HEALTH CENTER-SUMMIT, 36500 AURORA DRIVE, SUMMIT, WI 530662

06/26/2018 Page 159 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1382GENESIS HOUSE - LUTHERAN SOCIAL SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1994

(262) 544-1321

(262) [email protected] AKER

County: WaukeshaWAUKESHA, WI 531881002 MOTOR AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 07/01/2018 06/30/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3107HOPE FOR A BETTER TOMORROW

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/201812/01/201612/01/2015

(262) 910-1653

(262) [email protected]. SHEILA GISSIBL

County: WaukeshaWAUKESHA, WI 531882607 N GRANDVIEW BLVD, #110

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2016 11/30/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2016 11/30/2018

Services

NO BRANCH LOCATIONS

3186IRIS HEALTH CLINIC LLC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/09/201803/09/2018

(262) 753-6897

(262) [email protected] BRUNZELLE

County: WaukeshaWAUKESHA, WI 53186403 N GRAND AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/09/2018 02/28/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/09/2018 02/28/2019

Services

NO BRANCH LOCATIONS

3124LSS OF WI & UPPER MI CEPHAS HOUSE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201705/11/2016

(262) 549-6771

(262) [email protected] ADAMUS

County: WaukeshaWAUKESHA, WI 53189325 SENTINEL DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 05/01/2017 04/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 160 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1974PROHEALTH CARE MEDICAL ASSOCIATES, INC. BEHAVIORAL HEALTH SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201806/01/1986

(262) 928-5096

(262) [email protected]. KIRK YAUCHLER

County: WaukeshaWAUKESHA, WI 53188721 AMERICAN AVENUE #501

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - DELAFIELD, 2750 GOLF ROAD, DELAFIELD, WI 530181

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - WATERTOWN, 109 AIR PARK DR, WATERTOWN, WI 530941

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - BIG BEND RD, 2130 BIG BEND ROAD, WAUKESHA, WI 53189

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - BROOKFIELD, 2085 NORTH CALHOUN RD, BROOKFIELD, WI 53005

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - HARTLAND, 1500 WALNUT RIDGE DR, HARTLAND, WI 53029

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - MORELAND BLVD., 717 WEST MORELAND BLVD, WAUKESHA, WI 53188

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - MUKWONAGO, 240 WEST MAPLE AVE, MUKWONAGO, WI 53149

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - MUSKEGO, S69 W15636 JANESVILLE RD, MUSKEGO, WI 53150

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - NEW BERLIN, 13900 WEST NATIONAL AVE, NEW BERLIN, WI 53151

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - OCONOMOWOC, 1185 CORPORATE CENTER DR SUITE 175 - 320, OCONOMOWOC, WI 53066

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - PEWAUKEE, N16W24131 RIVERWOOD DR., WAUKESHA, WI 53188

2

01/01/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS - SUSSEX, N57 W24950 N CORPORATE CIRCLE, SUSSEX, WI 53089

2

05/04/2018 12/31/2019PHCMA, INC. BEHAVIORAL HEALTH SVS- BARSTOW ST, 210 NW BARSTOW ST, WAUKESHA, WI 53188

2

05/04/2018 12/31/2019PHCMA, INC.BEHAVIORAL HLTH SVS - BROOKFIELD, 195 DISCOVERY DR, BROOKFIELD, WI 530452

1748QUALITY ADDICTION MANAGEMENT, INC DBA WAUKESHA COMPREHENSIVE TREATMENT CTR

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201803/01/201604/01/1994

(262) 549-6698

(262) [email protected] SCHMITZ

County: WaukeshaWAUKESHA, WI 531882422 N. GRANDVIEW BOULEVARD

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 03/01/2016 08/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2016 08/31/2018

Services

NO BRANCH LOCATIONS

3129SALS RECOVERY CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201707/18/2016

(262) 753-6897

(262) [email protected] BRUNZELLE

County: WaukeshaWAUKESHA, WI 53186223 W WISCONSIN AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2017 07/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 161 of 172

Substance Abuse Program Directory By County, City, and Provider Name

3024SIXTEENTH STREET COMMUNITY HEALTH CENTERS DBA WAUKESHA COMMUNITY HEALTH CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201704/01/2014

(414) 408-5087

(262) [email protected] ELENA PEREZ, PHD

County: WaukeshaWAUKESHA, WI 53186309 EAST NORTH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

3042WAUKESHA COUNTY DHHS CCS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2014

(262) 896-8180

(262) [email protected] BIRDEAU

County: WaukeshaWAUKESHA, WI 531881501 AIRPORT ROAD

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020WAUKESHA CO DHHS HUMAN SERVICES CENTER, 514 RIVERVIEW AVE, WAUKESHA, WI 531881

1972WAUKESHA COUNTY HEALTH AND HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201710/01/1990

(262) 896-8046

(262) [email protected] HAAS

County: WaukeshaWAUKESHA, WI 531881501 AIRPORT ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

1971WAUKESHA COUNTY MENTAL HEALTH CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/01/1987

(262) 896-8046

(262) [email protected] LEWIS

County: WaukeshaWAUKESHA, WI 531881501 AIRPORT ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 05/01/2018 04/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

1970WAUKESHA COUNTY, DBA WAUKESHA COUNTY DHHS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/201905/01/201704/01/1984

(262) 548-7656

(262) [email protected] OWLEY

County: WaukeshaWAUKESHA, WI 53188514 RIVERVIEW AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2017 04/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2017 04/30/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2017 04/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2017 04/30/2019WAUKESHA COUNTY MENTAL HEALTH CENTER, 1501 AIRPORT RD, WAUKESHA, WI 531882

06/26/2018 Page 162 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1976WAUKESHA MEMORIAL HOSPITAL

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201706/01/1986

(262) 928-8126

(262) [email protected] GRZYBOWSKI

County: WaukeshaWAUKESHA, WI 53188725 AMERICAN AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2017 12/31/2018

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2017 12/31/2018

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 01/01/2017 12/31/2018

MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2017 12/31/2018

MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 163 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WAUPACAWAUPACA

2123WAUPACA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201812/01/1981

(715) 258-6409

(715) [email protected] NICHOLS

County: WaupacaWAUPACA, WI 54981811 HARDING STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3109WAUPACA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201803/01/2016

(715) 258-6409

(715) [email protected] NICHOLS

County: WaupacaWAUPACA, WI 54981811 HARDING ST

CCS Affiliaton: 01/01/2016Begin: End: Lead:Central Wisconsin Health Partnership V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

1977WAUPACA COUNTY DEPT OF HEALTH AND HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/201907/01/201712/01/1981

(715) 258-6409

(715) [email protected] NICHOLS

County: WaupacaWAUPACA, WI 54981811 HARDING STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2017 06/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2017 06/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2017 06/30/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2017 06/30/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2017 06/30/2019WAUPACA CO DEPT OF HEALTH & HUMAN SERV, 1405 MILL ST, NEW LONDON, WI 549611

06/26/2018 Page 164 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WAUSHARAWAUTOMA

3191FAMILY HEALTH LA CLINICA

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/05/201803/05/2018

(920) 787-4737

(920) [email protected] AMBROSIUS

County: WausharaWAUTOMA, WI 54982400 SOUTH TOWNLINE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/05/2018 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/05/2018 02/28/2019

Services

NO BRANCH LOCATIONS

1980WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201610/01/1975

(920) 787-0421

(920) [email protected] MORGAN-JONES

County: WausharaWAUTOMA, WI 54982230 W PARK STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

CSAS-PREVENTION DHS 75.04 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2016 10/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2016 10/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2016 10/31/2018BERLIN HIGH SCHOOL, 222 MEMORIAL DRIVE, BERLIN, WI 549233

11/01/2016 10/31/2018TRI-COUNTY HIGH SCHOOL, 409 S WEST STREET, PLAINFIELD, WI 549663

11/01/2016 10/31/2018WAUTOMA HIGH SCHOOL, 514 S CAMBRIDGE STREET, WAUTOMA, WI 549823

11/01/2016 10/31/2018WESTFIELD AREA MIDDLE/HIGH SCHOOL, N 7046 COUNTY ROAD CH, WESTFIELD, WI 539643

11/01/2016 10/31/2018WILD ROSE SCHOOL DISTRICT, 600 PARK AVE, WILD ROSE, WI 549843

1979WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201608/01/1997

(920) 787-0421

(920) [email protected] MORGAN-JONES

County: WausharaWAUTOMA, WI 54982230 W PARK STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

2618WAUSHARA COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201610/19/2005

(920) 787-0421

(920) [email protected] MORGAN-JONES

County: WausharaWAUTOMA, WI 54982230 W PARK STREET

CCS Affiliaton: 09/01/2014 12/31/2015Begin: End: Lead:Central Wisconsin Health Partnership

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 165 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WINNEBAGOMENASHA

1355THE SAMARITAN COUNSELING CENTER OF THE FOX VALLEY

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/201903/01/201703/01/1983

(920) 886-9357

(920) [email protected] BERBERT

County: WinnebagoMENASHA, WI 549521478 KENWOOD DRIVE SUITE 1

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2017 02/28/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2017 02/28/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2017 02/28/2019PROJECT OPEN DOOR IMMANUEL UNITED CHURCH, 510 SULLIVAN AVENUE, KAUKAUNA, WI 541301

03/01/2017 02/28/2019THE SAMARITAN COUNSELING CTR FOX VALLEY, 1478 MIDWAY ROAD, MENASHA, WI 549521

03/01/2017 02/28/2019THE SAMARITAN COUNSELING CTR FOX VALLEY, 110 CHURCH AVENUE, OSHKOSH, WI 549012

03/01/2017 02/28/2019THE SAMARITAN COUNSELING CTR FOX VALLEY, 709 W PINE STREET, NEW LONDON, WI 549612

2052THEDACARE BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/31/1998

(920) 720-3719

(920) [email protected] PAGEL

County: WinnebagoMENASHA, WI 549521095 MIDWAY ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 1405 MILL STREET, NEW LONDON, WI 549611

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 100 COUNTY ROAD B, SHAWANO, WI 541662

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 2500 E CAPITAL DRIVE, APPLETON, WI 549112

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 333 GREEN BAY RD, NEENAH, WI 549562

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 600 N WESTHAVEN DRIVE, OSHKOSH, WI 549012

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 902 RIVERSIDE DRIVE, #204, WAUPACA, WI 549812

NEENAH

2968ESPRIT COUNSELING AND CONSULTING

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/26/2012

(920) 243-0341

(920) [email protected] JO LARSON

County: WinnebagoNEENAH, WI 5495640 JEWELERS PARK DRIVE #200

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

06/26/2018 Page 166 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1946THEDACARE BEHAVIORAL HEALTH AT THEDA CLARK MEDICAL CENTER

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201703/01/1983

(920) 729-2906

(920) [email protected] BUTTS

County: WinnebagoNEENAH, WI 54956130 SECOND STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 02/01/2017 01/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

2006WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201607/01/1988

(920) 720-9682

(920) [email protected] DAEHN PHD

County: WinnebagoNEENAH, WI 54956211 N COMMERCIAL STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

2278WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201611/01/2000

(920) 720-9682

(920) [email protected] AMOS

County: WinnebagoNEENAH, WI 54956211 N. COMMERCIAL STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

OSHKOSH

3089AMS OF WISCONSIN, LLC - OSHKOSH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201911/01/201609/04/2015

(920) 232-2342

(920) [email protected] WESTPHAL

County: WinnebagoOSHKOSH, WI 54904505 S WASHBURN STREET

Service Begin/End DatesAdm Code

CSAS-NARCOTIC TREATMENT DHS 75.15 11/01/2016 09/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 09/30/2019

Services

NO BRANCH LOCATIONS

3004GENESIS BEHAVIORAL SVCS OSHKOSH RESIDENTIAL PROGRAM

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201709/23/2013

(920) 235-0336

(414) [email protected] SANCHEZ

County: WinnebagoOSHKOSH, WI 54901304 OTTER AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 09/01/2017 08/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 167 of 172

Substance Abuse Program Directory By County, City, and Provider Name

1613MERCY COUNSELING SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201702/01/1995

(920) 236-8591

(920) [email protected] MCGLYNN

County: WinnebagoOSHKOSH, WI 549042700 W9TH AVE STE 102

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2017 08/31/2019CATALPA HEALTH - AFFINITY BEHAVORIAL HEALTH, 444 N WESTHILL BLVD, APPLETON, WI 549141

1608MERCY MEDICAL CENTER

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201909/01/201702/01/1982

(920) 223-3404

(920) [email protected] MCGLYNN

County: WinnebagoOSHKOSH, WI 54904500 S OAKWOOD ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2017 08/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2017 08/31/2019

Services

NO BRANCH LOCATIONS

1710NOVA COUNSELING SERVICES, INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201811/01/1985

(920) 231-4246

(920) [email protected] WILLEFORD

County: WinnebagoOSHKOSH, WI 549013240 JACKSON STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 05/01/2018 04/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

2007WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201610/01/1975

(920) 236-1157

(920) [email protected] DAEHN

County: WinnebagoOSHKOSH, WI 54903220 WASHINGTON AVENUE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 11/01/2016 10/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2016 10/31/2018

CSAS-PREVENTION DHS 75.04 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2016 10/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2016 10/31/2018

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

06/26/2018 Page 168 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2266WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201811/01/201610/01/1975

(920) 236-1157

(920) [email protected] HOODIE

County: WinnebagoOSHKOSH, WI 54903220 WASHINGTON AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2016 10/31/2018

Services

NO BRANCH LOCATIONS

2579WINNEBAGO COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/201904/01/201703/09/2005

(920) 303-4792

(920) [email protected] DAEHN PHD

County: WinnebagoOSHKOSH, WI 54903220 WASHINGTON AVENUE

CCS Affiliaton: 09/01/2014Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2017 03/31/2019

Services

NO BRANCH LOCATIONS

WINNEBAGO

2008WINNEBAGO MENTAL HEALTH INSTITUTE

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/201911/01/201710/01/1975

(920) 237-2043

(920) [email protected] SPEECH

County: WinnebagoWINNEBAGO, WI 54985TREFFERT DRIVE & BUTLER AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 11/01/2017 10/31/2019

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 11/01/2017 10/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2017 10/31/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 169 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WINONAWINONA

2823HIAWATHA VALLEY MENTAL HEALTH CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201609/21/2009

(507) 453-6267

(507) [email protected] HANSON

County: WinonaWINONA, MN 55987166 MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2016 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2016 08/31/2018

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2016 08/31/2018HIAWATHA VALLEY MENTAL HEALTH CENTER, 313 4TH ST. S, LA CROSSE, WI 546011

09/01/2016 08/31/2018HIAWATHA VALLEY MENTAL HEALTH CENTER, 611 BROADWAY AVENUE, #100, WABASHA, MN 55981

1

09/01/2016 08/31/2018HIAWATHA VALLEY MENTAL HEALTH CENTER, 2835 S. SERVICE DR., STE. 103, RED WING, MN 55066

2

06/26/2018 Page 170 of 172

Substance Abuse Program Directory By County, City, and Provider Name

WOODMARSHFIELD

3135MARSHFIELD CLINIC CENTER FOR COMMUNITY OUTREACH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201710/01/2016

(715) 389-8779

(715) [email protected] LUTHER

County: WoodMARSHFIELD, WI 544491701 N FIG AVE

Service Begin/End DatesAdm Code

CSAS-PREVENTION DHS 75.04 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

1709NORWOOD HEALTH CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/201902/01/201704/01/1980

(715) 389-2266

(715) [email protected] BRUCE

County: WoodMARSHFIELD, WI 544491600 N. CHESTNUT AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 02/01/2017 01/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2017 01/31/2019

Services

NO BRANCH LOCATIONS

3078OLSON PROFESSIONAL COUNSELING SERVICES LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201801/01/201701/05/2015

(715) 384-7881

(715) [email protected] OLSON

County: WoodMARSHFIELD, WI 54449252 S CENTRAL AVE STE 24

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2017 12/31/2018

Services

NO BRANCH LOCATIONS

WISCONSIN RAPIDS

1208CLINICAL SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/201910/01/201710/01/1988

(715) 424-3441

(715) [email protected] MICHAEL J NELSON

County: WoodWISCONSIN RAPIDS, WI 54495420 - 1ST AVENUE SOUTH

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 10/01/2017 09/30/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2017 09/30/2019

Services

NO BRANCH LOCATIONS

06/26/2018 Page 171 of 172

Substance Abuse Program Directory By County, City, and Provider Name

2678WOOD COUNTY HUMAN SERVICES CCS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201808/01/1977

(715) 421-2266

(715) [email protected] SCHEIDEGGER

County: WoodWISCONSIN RAPIDS, WI 54494111 W JACKSON ST

CCS Affiliaton: 09/01/2014Begin: End: Lead:Portage Wood Partnership

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

2019WOOD COUNTY HUMAN SERVICES DEPARTMENT

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201808/01/1977

(715) 421-2266

(715) [email protected] SCHUELER SHEVELAND

County: WoodWISCONSIN RAPIDS, WI 54494111 W JACKSON ST

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 07/01/2018 06/30/2020

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2018 06/30/2020

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020NORWOOD HEALTH CARE BRANCH OFFICE, 1600 NORTH CHESTNUT, MARSHFIELD, WI 544492

06/26/2018 Page 172 of 172