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 271 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
1831<br />
SHAWANO COUNTY DEPARTMENT OF<br />
COMMUNITY PROGRAMS<br />
JOANN LISKA<br />
504 LAKELAND ROAD<br />
SHAWANO, WI 54166<br />
County: Shawano<br />
joann.liska@co.shawano.wi.us<br />
Phone: (715) 524-6888<br />
Fax: (715) 526-5542<br />
Surveyor: Frank Bellaire<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 />
03/01/1977<br />
01/01/2011<br />
12/31/2012<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic with Telehealth DHS 35<br />
CSAS-Emergency Outpatent with Telehealth DHS 75.05<br />
CSAS-Emergency Outpatient DHS 75.05<br />
CSAS-Outpatient Treatment DHS 75.13<br />
CSAS-Outpatient Treatment with Telehealth DHS 75.13<br />
<strong>Mental</strong> <strong>Health</strong>-Emergency Service 3 DHS 34.3<br />
<strong>Mental</strong> <strong>Health</strong>-Emergency Service 3 w/Telehealth DHS 34.3<br />
1832<br />
SHAWANO MEDICAL CENTER<br />
PENNY BLOCK<br />
309 N. BARTLETT STREET<br />
SHAWANO, WI 54166<br />
County: Shawano<br />
pblock@shawanomed.org<br />
Phone: (715) 526-7210<br />
Fax: (715) 526-7205<br />
Surveyor: Bradley Jahr<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 />
10/01/1978<br />
04/01/2011<br />
03/31/2013<br />
CSAS-Medically Managed Inpatient Detox DHS 75.06<br />
2315<br />
SHEBOYGAN COUNTY DEPARTMENT OF HEALTH<br />
AND HUMAN SERVICES CSP<br />
ERIC BRUNNICH<br />
1011 N. 8TH STREET<br />
SHEBOYGAN, WI 53081<br />
County: Sheboygan<br />
brunneb@co.sheboygan.wi.us<br />
Phone: (920) 459-3199<br />
Fax: (920) 459-4353<br />
Surveyor: Frank Bellaire<br />
Services<br />
NO BRANCH LOCATIONS<br />
01/01/2011 12/31/2012<br />
01/01/2011 12/31/2012<br />
01/01/2011 12/31/2012<br />
01/01/2011 12/31/2012<br />
01/01/2011 12/31/2012<br />
01/01/2011 12/31/2012<br />
01/01/2011 12/31/2012<br />
01/01/2011 12/31/2012<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
07/01/1996<br />
10/01/2011<br />
09/30/2013<br />
<strong>Mental</strong> <strong>Health</strong>-Community Support Program DHS 63<br />
NO BRANCH LOCATIONS<br />
04/01/2011 03/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
10/01/2011 09/30/2013
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