Mental Health and Substance Abuse Programs in alphabetical

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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 130 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1413 HO-CHUNK NATION DEPARTMENT OF HEALTH DIVISION OF BEHAVIORAL HEALTH JULIE ABBOTT-JONES N6250 LUMBERJACK GUY ROAD BLACK RIVER FALLS, WI 54615 County: Jackson julie.abott-jones@ho-chunk.com Phone: (715) 284-9851 Fax: (715) 284-3434 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/01/1992 11/01/2011 10/31/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 2520 HOLISTIC WELLNESS CENTER, LLC JEFF S. HOLLOWELL PHD 675 N. BROOKFIELD ROAD, #101 BROOKFIELD, WI 53045 County: Waukesha holisticwellness@att.net Phone: (262) 641-9300 Fax: (262) 641-9307 Surveyor: Mark Isaacs Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates NEKOOSA HEALTH OFFICE Tier 2 916 CHAK-HAH-CHEE LANE 11/01/2011 NEKOOSA, WI 54457 10/31/2012 THREE RIVERS HOUSE Tier 2 724 MAIN STREET 11/01/2011 LA CROSSE, WI 54601 10/31/2012 TOMAH HEALTH OFFICE Tier 2 27374 HWY 21 EAST 11/01/2011 TOMAH, WI 54660 10/31/2012 WELLNESS CENTER HEALTH OFFICE Tier 2 S2845 WHITE EAGLE ROAD 11/01/2011 BARABOO, WI 53913 10/31/2012 WITTENBERG HEALTH OFFICE Tier 2 N7240 HWY 49 NORTH 11/01/2011 WITTENBERG, WI 54499 10/31/2012 Administrative Code Chapter Service Begin/End Dates 05/18/2004 06/01/2011 05/31/2013 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 11/01/2011 10/31/2012 11/01/2011 10/31/2012 Administrative Code Chapter Service Begin/End Dates 06/01/2011 05/31/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 131 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1416 HOLY FAMILY MEMORIAL MEDICAL CENTER NEIL MURPHY 2300 WESTERN AVENUE MANITOWOC, WI 54221 County: Manitowoc No Email Address Provided Phone: (920) 320-2499 Fax: No Number Provided Surveyor: Frank Bellaire Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/01/1985 03/01/2008 02/28/2010 CSAS-Medically Managed Inpatient Detox DHS 75.06 1024 HOPE COUNCIL ON ALCOHOL & OTHER DRUG ABUSE, INC. GUIDA BROWN 5942 - SIXTH AVENUE KENOSHA, WI 53140 County: Kenosha info@hopecouncil.org Phone: (262) 658-8166 Fax: (262) 658-8210 Surveyor: Mark Isaacs Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates NO BRANCH LOCATIONS Administrative Code Chapter Service Begin/End Dates 02/15/1990 03/01/2011 02/28/2013 CSAS-Intervention DHS 75.16 1418 HOPE HAVEN, INC. JAMES CRAWFORD 425 W. JOHNSON STREET MADISON, WI 53703 County: Dane hopehaven_james@yahoo.com Phone: (608) 251-8881 Fax: (608) 251-2926 Surveyor: William Rohner Services NO BRANCH LOCATIONS 03/01/2008 02/28/2010 Administrative Code Chapter Service Begin/End Dates 02/01/1982 12/01/2011 11/30/2013 CSAS-Medically Monitored Treatment DHS 75.11 NO BRANCH LOCATIONS 03/01/2011 02/28/2013 Administrative Code Chapter Service Begin/End Dates 12/01/2011 11/30/2013
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