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 50 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
1133<br />
CATHOLIC CHARITIES OF THE ARCHDIOCESE OF<br />
MILWAUKEE, INC.<br />
RICARDO CISNEROS<br />
503 WISCONSIN AVENUE<br />
SHEBOYGAN, WI 53081<br />
County: Sheboygan<br />
rcisneros@ccmke.org<br />
Phone: (920) 458-5726<br />
Fax: (920) 458-5826<br />
Surveyor: William Goehr<strong>in</strong>g<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 />
04/01/1983<br />
05/01/2011<br />
04/30/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
1135<br />
CATHOLIC CHARITIES OF THE ARCHDIOCESE OF<br />
MILWAUKEE, INC.<br />
RICARDO CISNEROS<br />
1111 DOUGLAS AVENUE (MCCARTHY HALL)<br />
RACINE, WI 53402<br />
County: Rac<strong>in</strong>e<br />
rcisneros@ccmke.org<br />
Phone: (262) 637-8888<br />
Fax: (262) 637-0695<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 />
CATHOLIC CHARITIES ARCHDIOCESE OF<br />
MILW INC<br />
406 JEFFERSON STREET<br />
WEST BEND, WI 53090<br />
CATHOLIC CHARITIES ARCHDIOCESE OF<br />
MILW INC<br />
191 S MAIN STREET<br />
FOND DU LAC, WI 54935<br />
Tier 1<br />
05/01/2011<br />
04/30/2013<br />
Tier 1<br />
05/01/2011<br />
04/30/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
06/01/1981<br />
07/01/2012<br />
06/30/2014<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
1140<br />
CATHOLIC CHARITIES, DIOCESE OF GREEN BAY,<br />
INC.<br />
TED PHERNETTON<br />
1825 RIVERSIDE DRIVE<br />
GREEN BAY, WI 54305<br />
County: Brown<br />
TPhernetton@gbdioc.org<br />
Phone: (920) 272-8234<br />
Fax: (920) 437-4067<br />
Surveyor: Frank Bellaire<br />
Services<br />
05/01/2011 04/30/2013<br />
CATHOLIC CHARITIES OF MILW - RACINE Tier 1<br />
4400 - 22ND AVENUE<br />
07/01/2012<br />
KENOSHA, WI 53144<br />
06/30/2014<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
01/01/1988<br />
02/01/2011<br />
01/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
07/01/2012 06/30/2014<br />
CATHOLIC CHARITIES OF GREEN BAY Tier 2<br />
844 PIERCE AVENUE, SUITE 102<br />
08/01/2012<br />
MARINETTE, WI 54143<br />
01/31/2013<br />
CATHOLIC CHARITIES OF GREEN BAY Tier 1<br />
20 SOUTH FIRST STREET<br />
02/01/2011<br />
STURGEON BAY, WI 54235<br />
06/30/2011<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
02/01/2011 01/31/2013
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