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 196 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1617 MERITER-NEWSTART OUTPATIENT CLINIC MICHAEL GERST 1015 GAMMON LANE MADISON, WI 53719 County: Dane No Email Address Provided Phone: (608) 417-8144 Fax: (608) 274-3457 Surveyor: William Rohner Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 01/01/1988 12/01/2010 11/30/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 1668 MERITER'S CHILD & ADOLESCENT PSYCHIATRIC HOSPITAL SUSAN JANTY 8001 RAYMOND ROAD MADISON, WI 53719 County: Dane SJanty@meriter.com Phone: (608) 417-5346 Fax: (608) 417-5334 Surveyor: William Rohner 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 01/01/1984 12/01/2010 11/30/2012 Mental Health-Adolescent Inpatient DHS 61.79 Mental Health-Day Treatment for Children 2 DHS 40.11(2)(b) 1619 META HOUSE, INC (SHOREWOOD CAMPUS) AKA META III CHRISTINE ULLSTRUP 3924-26 N. MARYLAND AVENUE MILWAUKEE, WI 53211 County: Milwaukee cullstrup@metahouse.org Phone: (414) 962-1200 Fax: (414) 962-2305 Surveyor: William Goehring Services NO BRANCH LOCATIONS 12/01/2010 11/30/2012 12/01/2010 11/30/2012 Administrative Code Chapter Service Begin/End Dates 02/01/1995 02/01/2011 01/31/2013 CSAS-Medically Monitored Treatment DHS 75.11 CSAS-Transitional Residential DHS 75.14 NO BRANCH LOCATIONS 12/01/2010 11/30/2012 12/01/2010 11/30/2012 Administrative Code Chapter Service Begin/End Dates 02/01/2011 01/31/2013 02/01/2011 01/31/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 197 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2022 META HOUSE, INC (SOUTH CAMPUS) AKA RIVERWEST CHRISTINE ULLSTRUP 2618 N. BREMEN STREET MILWAUKEE, WI 53212 County: Milwaukee mail@metahouse.org Phone: (414) 962-1200 Fax: (414) 962-2305 Surveyor: William Goehring Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/20/1998 02/01/2011 01/31/2013 CSAS-Medically Monitored Treatment DHS 75.11 CSAS-Transitional Residential DHS 75.14 1620 META HOUSE, INC. (NORTH CAMPUS) CHRISTINE ULLSTRUP 2626 N. BREMEN STREET MILWAUKEE, WI 53212 County: Milwaukee cullstrup@metahouse.org Phone: (414) 962-1200 Fax: (414) 962-2305 Surveyor: William Goehring 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 02/01/1995 08/01/2011 07/31/2013 CSAS-Medically Monitored Treatment DHS 75.11 CSAS-Transitional Residential DHS 75.14 2172 META HOUSE, INC. CHRISTINE ULLSTRUP 2625 N WEIL STREET MILWAUKEE, WI 53212 County: Milwaukee cullstrup@metahouse.org Phone: (414) 962-1200 Fax: (414) 962-2305 Surveyor: William Goehring Services NO BRANCH LOCATIONS 02/01/2011 01/31/2013 02/01/2011 01/31/2013 Administrative Code Chapter Service Begin/End Dates 11/24/1999 12/01/2010 11/30/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Day Treatment DHS 75.12 CSAS-Outpatient Treatment DHS 75.13 NO BRANCH LOCATIONS 08/01/2011 07/31/2013 08/01/2011 07/31/2013 Administrative Code Chapter Service Begin/End Dates 12/01/2010 11/30/2012 12/01/2010 11/30/2012 12/01/2010 11/30/2012
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