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 39 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2198<br />
BELOIT AREA COMMUNITY HEALTH CENTER<br />
LYNN LARSEN<br />
74 ECLIPSE CENTER<br />
BELOIT, WI 53511<br />
County: Rock<br />
llarsen@bachc.com<br />
Phone: (608) 299-3309<br />
Fax: (608) 361-0312<br />
Surveyor: William Rohner<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 />
02/01/2000<br />
02/01/2011<br />
01/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
1099<br />
BELOIT INNER CITY COUNCIL, INC./DIVISION OF<br />
TELLURIAN UCAN<br />
BARBARA RUCKER<br />
74 ECLIPSE CENTER<br />
BELOIT, WI 53511<br />
County: Rock<br />
Brucker@tellurian.org<br />
Phone: (608) 365-6600<br />
Fax: (608) 365-7787<br />
Surveyor: William Rohner<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 />
HEAD START Tier 1<br />
221 HENRY AVENUE<br />
02/01/2011<br />
BELOIT, WI 53511<br />
01/31/2013<br />
RACINE AREA COMMUNITY HEATLH<br />
CENTER<br />
Tier 2<br />
2405 NORTHWESTERN AVENUE<br />
02/01/2011<br />
RACINE, WI 53404<br />
01/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
05/01/1991<br />
05/01/2009<br />
04/30/2010<br />
CSAS-Outpatient Treatment DHS 75.13<br />
1100<br />
BELOIT MEMORIAL HOSPITAL-COUNSELING<br />
CARE CENTER<br />
GREG AMMON<br />
1969 W. HART ROAD<br />
BELOIT, WI 53511<br />
County: Rock<br />
gammon@beloitmemorialhospital.org<br />
Phone: (608) 364-5686<br />
Fax: (608) 363-5756<br />
Surveyor: William Rohner<br />
Services<br />
NO BRANCH LOCATIONS<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
07/01/1985<br />
12/01/2011<br />
11/30/2012<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
05/01/2009 04/30/2010<br />
JANESVILLE OCCUPATIONAL HEALTH Tier 1<br />
1409B CRESTON PARK DRIVE<br />
12/01/2011<br />
JANESVILLE, WI 53545<br />
11/30/2012<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
12/01/2011 11/30/2012<br />
12/01/2011 11/30/2012
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