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 216 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1679 NORTH CENTRAL HEALTH CARE FACILITIES LINCOLN HEALTH CARE CENTER MARGARET PARSONS 607 N. SALES STREET MERRILL, WI 54452 County: Lincoln mparsons@norcen.org Phone: (715) 536-9482 Fax: (715) 539-2972 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 03/01/1987 06/01/2009 05/31/2011 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 CSAS-Outpatient Treatment DHS 75.13 CSAS-Outpatient Treatment with Telehealth DHS 75.13 Mental Health-Emergency Service 3 DHS 34.3 Mental Health-Outpatient DHS 61.91 1677 NORTH CENTRAL HEALTH CARE FACILITIES AEKTA DASSOW 1100 LAKE VIEW DRIVE WAUSAU, WI 54403 County: Marathon adassow@norcen.org Phone: (715) 848-4600 Fax: (715) 845-6050 Surveyor: Bradley Jahr 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 10/01/1975 03/01/2011 02/28/2013 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 CSAS-Day Treatment DHS 75.12 CSAS-Medically Managed Inpatient Detox DHS 75.06 CSAS-Outpatient Treatment DHS 75.13 CSAS-Outpatient Treatment with Telehealth DHS 75.13 Mental Health-Adolescent Inpatient DHS 61.79 Mental Health-Emergency Service 3 DHS 34.3 Mental Health-Inpatient DHS 61.71 10/28/2009 02/28/2011 10/28/2009 02/28/2011 06/01/2009 02/28/2011 10/28/2009 02/28/2011 06/01/2009 05/31/2011 06/01/2009 10/27/2009 LANGLADE HEALTH CENTER Tier 2 1225 LANGLADE ROAD 03/01/2011 ANTIGO, WI 54409 02/28/2013 LINCOLN HEALTH CARE CENTER Tier 2 607 N SALES STREET, #309 03/01/2011 MERRILL, WI 54452 02/28/2013 LINCOLN HEALTH CARE CENTER-TOMAHAWK Tier 2 310 W WISCONSIN PO BOX 411 03/01/2011 TOMAHAWK, WI 54487 02/28/2013 Administrative Code Chapter Service Begin/End Dates 03/01/2011 02/28/2013 03/01/2011 02/28/2013 03/01/2011 02/28/2013 03/01/2011 02/28/2013 03/01/2011 02/28/2013 03/01/2011 02/28/2013 03/01/2011 02/28/2013 03/01/2011 02/28/2013 03/01/2011 02/28/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 217 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1681 NORTH CENTRAL HEALTH CARE LINCOLN HEALTHCARE CENTER MARGARET A. PARSONS 310 W. WISCONSIN AVENUE TOMAHAWK, WI 54487 County: Lincoln mparsons@norcen.org Phone: (715) 453-5381 Fax: (715) 539-2972 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 07/01/1992 03/01/2009 02/28/2011 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 CSAS-Outpatient Treatment DHS 75.13 CSAS-Outpatient Treatment with Telehealth DHS 75.13 Mental Health-Outpatient DHS 61.91 1682 NORTH SHORE CENTER, L.L.C. DR RAYMOND A GALLOPE 10303 N. PT. WASHINGTON RD., #203 MEQUON, WI 53092 County: Ozaukee No Email Address Provided Phone: (262) 241-5955 Fax: (262) 241-5926 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 06/19/1989 07/01/2008 06/30/2010 Mental Health-Outpatient DHS 61.91 1683 NORTH SHORE PSYCHOTHERAPY ASSOCIATES DANIELA JARAMILLO 5800 N BAYSHORE DRIVE #A250 GLENDALE, WI 53217 County: Milwaukee djaramida@tds.net Phone: (414) 962-6764 Fax: (414) 962-6765 Surveyor: William Goehring Services NO BRANCH LOCATIONS 10/28/2009 02/28/2011 10/28/2009 02/28/2011 03/01/2009 02/28/2011 10/28/2009 02/28/2011 03/01/2009 10/27/2009 Administrative Code Chapter Service Begin/End Dates 07/01/1980 10/01/2010 09/30/2012 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 07/01/2008 06/30/2010 Administrative Code Chapter Service Begin/End Dates 10/01/2010 09/30/2012
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Mental Health and Substance Abuse Programs in alphabetical

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