Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
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DEPARTMENT OF HEALTH SERVICES<br />
Division of Quality Assurance<br />
Pr<strong>in</strong>t Date: 08/28/2012<br />
Page 10 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2650<br />
AFFILIATED WELLNESS GROUP, LLC<br />
JENNIFER JONES<br />
2301 SUN VALLEY DRIVE, #209<br />
DELAFIELD, WI 53018<br />
County: Waukesha<br />
Bethechange8@hotmail.com<br />
Phone: (262) 646-8288<br />
Fax: (262) 646-8255<br />
Surveyor: Mark Isaacs<br />
Services<br />
Community <strong>Substance</strong> <strong>Abuse</strong> <strong>and</strong> <strong>Mental</strong> <strong>Health</strong><br />
Program Certification Directory<br />
By Provider Name & Certification Number<br />
Initial Certification/<br />
Certification Effective/<br />
Certification Expires<br />
02/27/2006<br />
03/01/2011<br />
02/28/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
1020<br />
AFFINITY HOUSE<br />
ANITA KUSTER<br />
3042 KILBOURNE AVENUE<br />
EAU CLAIRE, WI 54703<br />
County: Eau Claire<br />
akuster00@lsswis.org<br />
Phone: (715) 833-0436<br />
Fax: (715) 833-1505<br />
Surveyor: Polly Wong<br />
Services<br />
STATE OF WISCONSIN<br />
Bureau of <strong>Health</strong> Services<br />
PO Box 2969<br />
Madison, WI 53701-2969<br />
Tier/<br />
Branch Beg<strong>in</strong>/<br />
Branch Location(s) End Dates<br />
NO BRANCH LOCATIONS<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
03/01/1992<br />
03/01/2012<br />
02/28/2014<br />
CSAS-Transitional Residential DHS 75.14<br />
2651<br />
AFFINITY MEDICAL GROUP - BEHAVIORAL<br />
HEALTH<br />
TINA LECHNIR<br />
1531 S MADISON ST, #580<br />
APPLETON, WI 54915<br />
County: Outagamie<br />
tlechnirb @aff<strong>in</strong>ityhealth.org<br />
Phone: (920) 730-4411<br />
Fax: (920) 730-5481<br />
Surveyor: Frank Bellaire<br />
Services<br />
NO BRANCH LOCATIONS<br />
03/01/2011 02/28/2013<br />
03/01/2011 02/28/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
01/20/2005<br />
11/01/2011<br />
10/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
03/01/2012 02/28/2014<br />
AFFINITY MEDICAL GROUP-BEHAVIORAL<br />
HEALTH<br />
Tier 1<br />
2601 FIELDCREST<br />
11/01/2011<br />
KAUKAUNA, WI 54130<br />
10/31/2013<br />
AFFINITY MEDICAL GROUP-BEHAVIORAL<br />
HEALTH<br />
Tier 1<br />
200 PATRIOT DRIVE<br />
11/01/2011<br />
LITTLE CHUTE, WI 54140<br />
10/31/2013<br />
AFFINITY MEDICAL GROUP-BEHAVIORAL<br />
HEALTH<br />
Tier 1<br />
1855 S KOELLER<br />
11/01/2011<br />
OSHKOSH, WI 54902<br />
10/31/2013<br />
CALUMET MEDICAL CENTER CLINIC Tier 1<br />
618 MEMORIAL DRIVE<br />
11/01/2011<br />
CHILTON, WI 53014<br />
10/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
11/01/2011 10/31/2013
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