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 280 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2586 ST. CLARE HOSPITAL & HEALTH SERVICES ALICE FACEY 707 - 14TH STREET BARABOO, WI 53913 County: Sauk No Email Address Provided Phone: (608) 356-1400 Fax: (608) 356-1367 Surveyor: William Rohner Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 07/01/2004 04/01/2011 03/31/2012 CSAS-Medically Managed Inpatient Detox DHS 75.06 1856 ST. CROIX COUNTY HEALTH & HUMAN SERVICES KATHY HUSTON 1445 NORTH 4TH STREET NEW RICHMOND, WI 54017 County: Saint Croix kathyh@co.saint-croix.wi.us Phone: (715) 246-8204 Fax: (715) 246-8461 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 NO BRANCH LOCATIONS Administrative Code Chapter Service Begin/End Dates 01/01/1990 12/01/2010 11/30/2012 Mental Health-Community Support Program DHS 63 1855 ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BEHAVIORAL HEALTH STEVE KIRT 1445 N. 4TH STREET NEW RICHMOND, WI 54017 County: Saint Croix stevek@co.saint-croix.wi.us Phone: (715) 246-8256 Fax: (715) 246-8284 Surveyor: Polly Wong Services NO BRANCH LOCATIONS 04/01/2011 03/31/2012 Administrative Code Chapter Service Begin/End Dates 10/01/1975 12/01/2010 11/30/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 Mental Health-Emergency Service 3 DHS 34.3 NO BRANCH LOCATIONS 12/01/2010 11/30/2012 Administrative Code Chapter Service Begin/End Dates 12/01/2010 11/30/2012 12/01/2010 11/30/2012 12/01/2010 11/30/2012
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 281 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2217 ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC SARAH CORMELL 4404 STATE RD 70 WEBSTER, WI 54893 County: Burnett sarahc@stcroixtribalcenter.com Phone: (715) 349-8554 Fax: (715) 349-8528 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/01/2000 10/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 1860 ST. ELIZABETH HOSPITAL STEVIE REICH 1506 S. ONEIDA STREET APPLETON, WI 54915 County: Outagamie No Email Address Provided Phone: (920) 738-2930 Fax: (920) 730-5480 Surveyor: Frank Bellaire Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates ROUND LAKE CLINIC Tier 1 2230 - 60TH AVENUE 10/01/2011 LUCK, WI 54853 04/30/2013 Administrative Code Chapter Service Begin/End Dates 02/01/1984 11/01/2011 10/31/2013 CSAS-Day Treatment DHS 75.12 CSAS-Outpatient Treatment DHS 75.13 Mental Health-Adolescent Inpatient DHS 61.79 Mental Health-Day Treatment DHS 61.75 Mental Health-Day Treatment for Children 3 DHS 40.11(2)(c) Mental Health-Inpatient DHS 61.71 NO BRANCH LOCATIONS 10/01/2011 04/30/2013 10/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 11/01/2011 10/31/2013 11/01/2011 10/31/2013 11/01/2011 10/31/2013 11/01/2011 10/31/2013 11/01/2011 10/31/2013 11/01/2011 10/31/2013
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