Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
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 263 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2532<br />
ROGERS MEMORIAL HOSPITAL - CHILD &<br />
ADOLESCENT DAY TREATMENT<br />
KRISTINE KIM<br />
4600 SCHROEDER DRIVE<br />
BROWN DEER, WI 53223<br />
County: Milwaukee<br />
KKim@rogershospital.org<br />
Phone: (414) 355-9000<br />
Fax: (414) 355-9665<br />
Surveyor: William Goehr<strong>in</strong>g<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 />
07/13/2004<br />
07/01/2011<br />
06/30/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment for Children 2 DHS 40.11(2)(b)<br />
2070<br />
ROGERS MEMORIAL HOSPITAL - HERRINGTON<br />
RECOVERY CENTER<br />
CINDY SUSZEK<br />
34700 VALLEY ROAD<br />
OCONOMOWOC, WI 53066<br />
County: Waukesha<br />
csuszek@rogershospital.org<br />
Phone: (262) 646-1616<br />
Fax: (262) 646-3158<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 />
06/01/1998<br />
06/01/2011<br />
05/31/2013<br />
CSAS-Medically Monitored Treatment DHS 75.11<br />
CSAS-Transitional Residential DHS 75.14<br />
2920<br />
ROGERS MEMORIAL HOSPITAL - MADISON<br />
PARTIAL HOSPITALIZATION PROGRAM<br />
DAVID GEBAUER<br />
406 SCIENCE DRIVE, #110<br />
MADISON, WI 53711<br />
County: Dane<br />
DGebauer@rogershospital.org<br />
Phone: (608) 238-4411<br />
Fax: (608) 238-4412<br />
Surveyor: William Rohner<br />
Services<br />
NO BRANCH LOCATIONS<br />
07/01/2011 06/30/2013<br />
07/01/2011 06/30/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
10/13/2010<br />
11/01/2011<br />
10/31/2013<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treat/Children 2 w/Telehealth DHS 40.11(2)(b)<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment DHS 61.75<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment for Children 2 DHS 40.11(2)(b)<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment with Telehealth DHS 61.75<br />
NO BRANCH LOCATIONS<br />
06/01/2011 05/31/2013<br />
06/01/2011 05/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
11/01/2011 10/31/2013<br />
11/01/2011 10/31/2013<br />
11/01/2011 10/31/2013<br />
11/01/2011 10/31/2013
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