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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 149 of 335<br />

Certification Number/<br />

Certified Provider's Ma<strong>in</strong> Site/<br />

Email/Telephone<br />

2589<br />

KENOSHA COUNTY DEPARTMENT OF HUMAN<br />

SERVICES COMPREHENSIVE COMMUNITY<br />

SERVICES<br />

GERALD A THEIS, LCSW<br />

5407 8TH AVENUE<br />

KENOSHA, WI 53140<br />

County: Kenosha<br />

jtheis@co.kenosha.wi.us<br />

Phone: (262) 697-6524<br />

Fax: (262) 697-4655<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 />

05/01/2005<br />

05/01/2011<br />

04/30/2013<br />

Comprehensive Community Services (CCS) DHS 36<br />

2897<br />

KENOSHA HUMAN DEVELOPMENT SERVICES, INC<br />

COMMUNITY SUPPORT PROGRAM<br />

LISA A HAEN, MS<br />

5407 - 8TH AVENUE<br />

KENOSHA, WI 53140<br />

County: Kenosha<br />

khds@khds.com<br />

Phone: (262) 657-7188<br />

Fax: (262) 653-2080<br />

Surveyor: Mark Isaacs<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 />

01/01/2010<br />

01/01/2011<br />

12/31/2012<br />

<strong>Mental</strong> <strong>Health</strong>-Community Support Program DHS 63<br />

1460<br />

KENOSHA HUMAN DEVELOPMENT SERVICES,<br />

INC.<br />

KARI FOSS<br />

5407 - 8TH AVENUE<br />

KENOSHA, WI 53140<br />

County: Kenosha<br />

kfoss@khds.org<br />

Phone: (262) 657-7188<br />

Fax: (262) 653-2080<br />

Surveyor: Mark Isaacs<br />

Services<br />

NO BRANCH LOCATIONS<br />

05/01/2011 04/30/2013<br />

Adm<strong>in</strong>istrative<br />

Code Chapter Service Beg<strong>in</strong>/End Dates<br />

02/01/1977<br />

04/01/2012<br />

03/31/2014<br />

<strong>Mental</strong> <strong>Health</strong>-Emergency Service 3 DHS 34.3<br />

NO BRANCH LOCATIONS<br />

01/01/2011 12/31/2012<br />

Adm<strong>in</strong>istrative<br />

Code Chapter Service Beg<strong>in</strong>/End Dates<br />

04/01/2012 03/31/2014

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