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 264 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2214<br />
ROGERS MEMORIAL HOSPITAL - MILWAUKEE<br />
KATHY LOTZ<br />
11101 W. LINCOLN AVENUE<br />
WEST ALLIS, WI 53227<br />
County: Milwaukee<br />
klotz@rogershospital.org<br />
Phone: (414) 327-3000<br />
Fax: (414) 327-6045<br />
Surveyor: Demetrius Anderson<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 />
05/01/2000<br />
05/01/2012<br />
04/30/2014<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Day Treatment DHS 75.12<br />
CSAS-Medically Managed Inpatient Detox DHS 75.06<br />
CSAS-Medically Managed Inpatient Treatment DHS 75.10<br />
CSAS-Outpatient Treatment DHS 75.13<br />
<strong>Mental</strong> <strong>Health</strong>-Adolescent Inpatient DHS 61.79<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>-Inpatient DHS 61.71<br />
2433<br />
ROGERS MEMORIAL HOSPITAL CHILD AND<br />
ADOLESCENT DAY TREATMENT PROGRAM<br />
LAURA MIRHOSEINI, PSY D<br />
9916 - 75TH STREET<br />
KENOSHA, WI 53142<br />
County: Kenosha<br />
lmirhose<strong>in</strong>i@rogers.hospital.org<br />
Phone: (262) 942-4000<br />
Fax: (262) 942-7740<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 />
04/28/2003<br />
05/01/2012<br />
04/30/2014<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Day Treatment DHS 75.12<br />
CSAS-Outpatient Treatment DHS 75.13<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment for Children 2 DHS 40.11(2)(b)<br />
NO BRANCH LOCATIONS<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014<br />
05/01/2012 04/30/2014
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