Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
DEPARTMENT OF HEALTH SERVICES<br />
Division of Quality Assurance<br />
Pr<strong>in</strong>t Date: 08/28/2012<br />
Page 122 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
1520<br />
GUNDERSEN LUTHERAN MEDICAL CENTER, INC.<br />
BEHAVIORAL HEALTH<br />
ANN STEKEL<br />
1910 SOUTH AVENUE<br />
LA CROSSE, WI 54601<br />
County: La Crosse<br />
amstekel@gundluth.org<br />
Phone: (608) 782-7300<br />
Fax: (608) 775-4410<br />
Surveyor: Polly Wong<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 />
03/01/1982<br />
12/01/2010<br />
11/30/2012<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Day Treatment DHS 75.12<br />
CSAS-Medically Managed Inpatient Detox DHS 75.06<br />
CSAS-Narcotic Treatment DHS 75.15<br />
CSAS-Outpatient Treatment DHS 75.13<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment DHS 61.75<br />
<strong>Mental</strong> <strong>Health</strong>-Inpatient DHS 61.71<br />
1951<br />
GUNDERSEN LUTHERAN MEDICAL CENTER, INC.,<br />
UNITY HOUSE FOR MEN<br />
ANN STEKEL<br />
1922-1924 MILLER STREET<br />
LA CROSSE, WI 54601<br />
County: La Crosse<br />
amstekel@gundluth.org<br />
Phone: (608) 775-4753<br />
Fax: (608) 775-4791<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 />
GUNDERSEN LUTH MED CTR BEHAV<br />
HEALTH<br />
610 E TAYLOR STREET<br />
PRAIRIE DU CHIEN, WI 53821<br />
GUNDERSEN LUTH MED CTR BEHAV<br />
HEALTH<br />
218 W MAIN STREET<br />
SPARTA, WI 54656<br />
GUNDERSEN LUTH MED CTR BEHAV<br />
HEALTH<br />
18606 ERVIN STREET<br />
WHITEHALL, WI 54773<br />
GUNDERSEN LUTH MED CTR BEHAV<br />
HEALTH<br />
123 - 16TH AVENUE SOUTH<br />
ONALASKA, WI 54650<br />
GUNDERSEN LUTH MED CTR BEHAV<br />
HEALTH<br />
601 N SUPERIOR AVENUE<br />
TOMAH, WI 54660<br />
GUNDERSEN LUTH MED CTR BEHAV<br />
HEALTH<br />
3111 GUNDERSEN DRIVE<br />
ONALASKA, WI 54650<br />
Tier 2<br />
12/01/2010<br />
11/30/2012<br />
Tier 2<br />
12/01/2010<br />
11/30/2012<br />
Tier 2<br />
12/01/2010<br />
11/30/2012<br />
Tier 2<br />
12/01/2010<br />
11/30/2012<br />
Tier 2<br />
12/01/2010<br />
11/30/2012<br />
Tier 2<br />
12/01/2010<br />
11/30/2012<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
12/01/1993<br />
12/01/2010<br />
11/30/2012<br />
CSAS-Medically Monitored Treatment DHS 75.11<br />
CSAS-Transitional Residential DHS 75.14<br />
NO BRANCH LOCATIONS<br />
12/01/2010 11/30/2012<br />
10/12/2011 11/30/2012<br />
12/01/2010 11/30/2012<br />
12/01/2010 11/30/2012<br />
12/01/2010 11/30/2012<br />
10/12/2011 11/30/2012<br />
12/01/2010 11/30/2012<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
12/01/2010 11/30/2012<br />
12/01/2010 11/30/2012
Change language