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 266 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2947 SACRED HEART BEHAVIORAL HEALTH CLINIC KIM JOHNSON 4235 SOUTHTOWNE DRIVE EAU CLAIRE, WI 54701 County: Eau Claire kjohnson@shec.hshs.org Phone: (715) 717-5899 Fax: (715) 717-5898 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 10/31/2011 10/31/2011 09/30/2012 Mental Health Outpatient Clinic DHS 35 2029 SACRED HEART HOSPITAL THERESA MACKEY 900 W. CLAIREMONT AVENUE EAU CLAIRE, WI 54701 County: Eau Claire tmackey@shec.hshs.org Phone: (715) 717-4121 Fax: (715) 717-5898 Surveyor: Polly Wong Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates SACRED HEART HOSPITAL Tier 1 900 W. CLAIREMONT AVENUE 10/31/2011 EAU CLAIRE, WI 54701 09/30/2012 Administrative Code Chapter Service Begin/End Dates 02/01/1982 01/01/2011 12/31/2012 CSAS-Medically Managed Inpatient Detox DHS 75.06 Mental Health-Adolescent Inpatient DHS 61.79 Mental Health-Inpatient DHS 61.71 2793 SAFE HAVEN COUNSELING PAMELA OLSON 548 N LAKE AVENUE PHILLIPS, WI 54555 County: Price safehaven@pctcnet.net Phone: (715) 339-6453 Fax: (715) 339-6450 Surveyor: Bradley Jahr Services NO BRANCH LOCATIONS 10/31/2011 09/30/2012 Administrative Code Chapter Service Begin/End Dates 05/01/2008 05/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 01/01/2011 12/31/2012 01/01/2011 12/31/2012 01/01/2011 12/31/2012 SAFE HAVEN COUNSELING Tier 1 219 W 2ND STREET NORTH 05/01/2011 LADYSMITH, WI 54848 04/30/2013 Administrative Code Chapter Service Begin/End Dates 05/01/2011 04/30/2013 05/01/2011 04/30/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 267 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1471 SAINT MARY'S HOSPITAL KOLLER BEHAVIORAL HEALTH CHAD MCGRATH 1020 KABEL AVENUE RHINELANDER, WI 54501 County: Oneida No Email Address Provided Phone: (715) 369-2210 Fax: (715) 361-2920 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 08/01/1978 10/01/2009 04/30/2011 CSAS-Outpatient Treatment DHS 75.13 1820 SAINT MICHAEL'S HOSPITAL LAURIE ROBERTS 900 ILLINOIS AVENUE STEVENS POINT, WI 54481 County: Portage No Email Address Provided Phone: (715) 346-5400 Fax: (715) 346-5571 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 05/01/1978 10/01/2011 09/30/2013 CSAS-Medically Managed Inpatient Detox DHS 75.06 Mental Health-Inpatient DHS 61.71 1822 SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN DAN FEASTER 5900 MONONA DRIVE #100 MADISON, WI 53716 County: Dane dfeaster@aol.com Phone: (608) 663-0763 Fax: (608) 663-0765 Surveyor: William Rohner Services NO BRANCH LOCATIONS 10/01/2009 04/30/2011 Administrative Code Chapter Service Begin/End Dates 09/01/1994 08/01/2012 07/31/2013 Mental Health Outpatient Clinic DHS 35 SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN 109 FIRST STREET LODI, WI 53555 10/01/2011 09/30/2013 10/01/2011 09/30/2013 Tier 1 08/01/2012 07/31/2013 Administrative Code Chapter Service Begin/End Dates 08/01/2012 07/31/2013
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