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 200 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1630 MILWAUKEE CENTER FOR INDEPENDENCE CSP DANIELLE BIRDEAU 1040 S 70TH STREET MILWAUKEE, WI 53214 County: Milwaukee DBirdeau@mcfi.net Phone: (414) 476-9675 Fax: (414) 615-0627 Surveyor: Demetrius Anderson Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/01/1995 08/01/2009 07/31/2011 Mental Health-Community Support Program DHS 63 1640 MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION - SOUTHSIDE CSP LOIS GILDERSLEEVE 1201 WEST MITCHELL STREET MILWAUKEE, WI 53204 County: Milwaukee lgildersleeve@milwcnty.com Phone: (414) 454-4444 Fax: (414) 649-4639 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 05/01/1990 03/01/2011 02/28/2013 Mental Health-Community Support Program DHS 63 1634 MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION MOBILE URGENT TREATMENT TEAM CHRIS MORANO 9201 WATERTOWN PLANK ROAD MILWAUKEE, WI 53226 County: Milwaukee cmorano@wrapmilw.org Phone: (414) 257-7621 Fax: (414) 257-8126 Surveyor: William Goehring Services NO BRANCH LOCATIONS 08/01/2009 07/31/2011 Administrative Code Chapter Service Begin/End Dates 11/01/1996 11/01/2011 10/31/2013 Mental Health-Emergency Service 3 DHS 34.3 NO BRANCH LOCATIONS 03/01/2011 02/28/2013 Administrative Code Chapter Service Begin/End Dates 11/01/2011 10/31/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 201 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1632 MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION JIM KUBICEK 9455 WATERTOWN PLANK ROAD WAUWATOSA, WI 53226 County: Milwaukee Jkubicek@milwcnty.com Phone: (414) 257-7482 Fax: (414) 257-7019 Surveyor: William Goehring Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 08/01/1977 11/01/2011 10/31/2013 Mental Health-Adolescent Inpatient DHS 61.79 Mental Health-Day Treatment DHS 61.75 Mental Health-Emergency Service 3 DHS 34.3 Mental Health-Inpatient DHS 61.71 1637 MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION-DOWNTOWN CSP KRISTA DOUGHTY 734 N. 4TH STREET, #300 MILWAUKEE, WI 53203 County: Milwaukee KDoughty@milwcnty.com Phone: (414) 289-6090 Fax: (414) 226-4184 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 05/01/1990 05/01/2011 04/30/2013 Mental Health-Community Support Program DHS 63 1962 MILWAUKEE HEALTH SERVICE SYSTEMS D/B/A VALLEY HEALTH SERVICES JANE WILLIQUETTE 3301B NORTH BALLARD RD APPLETON, WI 54911 County: Outagamie Jwilliquette@crchealth.com Phone: (920) 733-4443 Fax: (920) 733-4796 Surveyor: Frank Bellaire Services NO BRANCH LOCATIONS 11/01/2011 10/31/2013 11/01/2011 10/31/2013 11/01/2011 10/31/2013 11/01/2011 10/31/2013 Administrative Code Chapter Service Begin/End Dates 07/09/1990 07/01/2012 06/30/2013 CSAS-Narcotic Treatment DHS 75.15 CSAS-Outpatient Treatment DHS 75.13 NO BRANCH LOCATIONS 05/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 07/01/2012 06/30/2013 07/01/2012 06/30/2013
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