Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 1 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LIBERTY VILLAGE OF ADAMS (0015835) COPPERLEAF MANAGEMENT GROUP INC Type: CBRF HCBS COMPLIANT (715) 254-4357 Class: CNA 550 W LIBERTY STREET ADVANCED AGED ADAMS WI 53910 KRISTA MENDYKE Gender - Capacity: M/F - 50 (608) 339-9444 JARETT YACH 1077 WILSHIRE BLVD Low/High rate: 3,850/5,850 EMOTIONALLY DISTURBED/MENTAL County: ADAMS STEVENS POINT WI 54481 Initial License: 11/30/2015 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL BIRCH HAVEN SENIOR LIVING BEARS HOLLOW (0015012 KELM ENTERPRISES INC Type: CBRF HCBS COMPLIANT (715) 682-2414 Class: CNA 1019 15TH AVE W ADVANCED AGED ASHLAND WI 54806 DALE KELM Gender - Capacity: M/F - 17 (715) 682-2534 CAITLYN HILLER 16955 BADGER ROAD Low/High rate: 3,390/5,828 EMOTIONALLY DISTURBED/MENTAL County: ASHLAND MASON WI 54856 Initial License: 07/01/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY Association Approval: WiCAL BIRCH HAVEN SENIOR LIVING EAGLES RIDGE (0015013) KELM ENTERPRISES INC Type: CBRF HCBS COMPLIANT (715) 682-2414 Class: CNA 224 22ND AVE W ADVANCED AGED ASHLAND WI 54806 DALE KELM Gender - Capacity: M/F - 8 (715) 682-1069 CAITLYN HILLER 16955 BADGER ROAD Low/High rate: 3,390/5,828 EMOTIONALLY DISTURBED/MENTAL County: ASHLAND MASON WI 54856 Initial License: 07/01/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY Association Approval: WiCAL BIRCH HAVEN SENIOR LIVING FALCONS CREST (0015014 KELM ENTERPRISES INC Type: CBRF HCBS COMPLIANT (715) 682-2414 Class: CNA 218 22ND AVE W ADVANCED AGED ASHLAND WI 54806 DALE KELM Gender - Capacity: M/F - 15 (715) 682-2775 CAITLYN HILLER 16955 BADGER ROAD Low/High rate: 3,390/5,828 EMOTIONALLY DISTURBED/MENTAL County: ASHLAND MASON WI 54856 Initial License: 07/01/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY Association Approval: WiCAL BIRCH HAVEN SENIOR LIVING TIMBERS EDGE (0015011) KELM ENTERPRISES INC Type: CBRF HCBS COMPLIANT (715) 682-2414 Class: CNA 1500 10TH ST W ADVANCED AGED ASHLAND WI 54806 DALE KELM Gender - Capacity: M/F - 15 (715) 682-2506 CAITLYN HILLER 16955 BADGER ROAD Low/High rate: 3,390/5,828 EMOTIONALLY DISTURBED/MENTAL County: ASHLAND MASON WI 54856 Initial License: 07/01/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY Association Approval: WiCAL AIN DAH ING INC (0017063) AIN DAH ING INC Type: CBRF ALCOHOL/DRUG DEPENDENT 2113 13 12 1/2 AVE (715) 296-3840 Class: AS CAMERON WI 54822 NATHAN WHITING Gender - Capacity: M/F - 12 (715) 458-1310 NATHAN WHITING PO BOX 142 Low/High rate: 2,800/3,100 County: BARRON BARRON WI 54812 Initial License: 03/16/2018 AURORA RES ALTERNATIVES INC 049 (510300) AURORA RESIDENTIAL ALTERNATIVES INC Type: CBRF HCBS COMPLIANT (715) 235-1839 Class: AA 1849 HWY 63 EMOTIONALLY DISTURBED/MENTAL COMSTOCK WI 54826 DEENA BLACK Gender - Capacity: M/F - 8 (715) 822-2245 JILL MATTSON P O BOX 68 Low/High rate: 5,475/5,475 PUBLIC FUNDING County: BARRON MENOMONIE WI 54751 Initial License: 01/01/1994 CAMBRIDGE SENIOR LIVING (0017325) CAMBRIDGE SENIOR LIVING Type: CBRF HCBS COMPLIANT (888) 651-7220 Class: CNA 820 BEAR PAW AVE ADVANCED AGED RICE LAKE WI 54868 HEATHER MICEK Gender - Capacity: M/F - 68 (888) 651-7220 KARLEY JOHNSON E2535 Cedar Road Low/High rate: 5,200/6,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: BARRON Eleva WI 54738 Initial License: 03/08/2019 PHYSICALLY DISABLED PUBLIC FUNDING *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 2 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CARE PARTNERS RICE LAKE II (0015820) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1639 KERN AVENUE ADVANCED AGED RICE LAKE WI 54868 JASON LINDEMANN Gender - Capacity: M/F - 20 (715) 719-0415 BROOKE LIPKA PO BOX 3006 Low/High rate: 4,700/5,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: BARRON OSHKOSH WI 54903 Initial License: 09/10/2015 PHYSICALLY DISABLED TERMINALLY ILL CHRISMARK HOME LLC (0016735) CHRISMARK HOME LLC Type: CBRF EMOTIONALLY DISTURBED/MENTAL (715) 736-1112 Class: CNA 1627 KERN AVE PHYSICALLY DISABLED RICE LAKE WI 54868 KELLY BANT Gender - Capacity: F - 15 (715) 736-1112 MICHELLE AMBORN 2699 23rd ST Low/High rate: 2,800/4,650 PUBLIC FUNDING County: BARRON RICE LAKE WI 54868 Initial License: 06/23/2017 COUNTRY TERRACE OF WISCONSIN INC (0009581) COUNTRY TERRACE OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1631 KERN AVENUE ADVANCED AGED RICE LAKE WI 54868 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 234-2012 BROOKE LIPKA PO BOX 3006 Low/High rate: 2,652/3,702 IRREVERSIBLE DEMENTIA/ALZHEIM County: BARRON OSHKOSH WI 54903-3006 Initial License: 03/01/2002 PHYSICALLY DISABLED TERMINALLY ILL HANSENS GROUP HOME (510307) SUSAN HANSEN Type: CBRF HCBS COMPLIANT (715) 537-5331 Class: AA 1190 17TH ST DEVELOPMENTALLY DISABLED BARRON WI 54812 SUSAN HANSEN Gender - Capacity: M/F - 7 (715) 537-5331 SUSAN & CARL HANSEN 1190 17TH ST Low/High rate: 1,500/4,000 PUBLIC FUNDING County: BARRON BARRON WI 54812 Initial License: 02/12/1985 HANSONS COUNTRY HOME (0018165) ASPEN RAE MANAGEMENT INC Type: CBRF HCBS COMPLIANT (715) 790-4727 Class: CA 1372 24 3/8 STREET DEVELOPMENTALLY DISABLED CAMERON WI 54822 ERIC MARSHALL Gender - Capacity: M/F - 8 (715) 859-2802 CINDIE SIMON 2637 16TH AVENUE Low/High rate: 3,000/6,000 EMOTIONALLY DISTURBED/MENTAL County: BARRON RICE LAKE WI 54868 Initial License: 07/20/2020 IRREVERSIBLE DEMENTIA/ALZHEIM INTEGRICARE CAMERON (0017730) JMAR OUTDOORS INC Type: CBRF HCBS COMPLIANT (715) 475-8829 Class: CS 1372 24 3/8 ST ADVANCED AGED CAMERON WI 54822 JAMIE MARSHALL Gender - Capacity: M/F - 8 (715) 859-6309 JAMIE MARSHALL PO BOX 335 Low/High rate: 2,000/6,000 DEVELOPMENTALLY DISABLED County: BARRON CAMERON WI 54822 Initial License: 01/01/2020 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING INTEGRICARE RICE LAKE (0017729) JMAR OUTDOORS INC Type: CBRF HCBS COMPLIANT (715) 475-8829 Class: AA 315 E ST PATRICK ST ADVANCED AGED RICE LAKE WI 54868 JAMIE MARSHALL Gender - Capacity: M/F - 8 (715) 719-0024 JAMIE MARSHALL PO BOX 335 Low/High rate: 2,000/6,000 DEVELOPMENTALLY DISABLED County: BARRON CAMERON WI 54822 Initial License: 01/01/2020 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING LSS BARRON AREA RESIDENTIAL TREATMENT (0016453) LUTHERAN SOCIAL SERVICES OF WI AND UPPE Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 214-9062 Class: AA 806 29 1/2 AVE CORRECTIONAL CLIENTS BARRONETT WI 54813 PAULA UPP Gender - Capacity: M - 8 (715) 214-9062 SHELLEY HAMMES 3003 N RICHMOND ST Low/High rate: 3,926/31,412 County: BARRON APPLETON WI 54911 Initial License: 02/01/2017 MAGNA HOUSE OF BARRON COUNTY LLC (0014442) MAGNA HOUSE OF BARRON COUNTY LLC Type: CBRF HCBS COMPLIANT (715) 292-0497 Class: AA 615 E SAWYER ST ALCOHOL/DRUG DEPENDENT RICE LAKE WI 54868 KAREN RUSCH Gender - Capacity: M/F - 8 (715) 736-6334 KAREN RUSCH 615 E SAWYER ST Low/High rate: 2,280/4,500 EMOTIONALLY DISTURBED/MENTAL County: BARRON RICE LAKE WI 54868 Initial License: 12/12/2012 MONROE MANOR (510311) VANYO INC Type: CBRF HCBS COMPLIANT (507) 387-4628 Class: CNA 508 E MONROE AVE ADVANCED AGED BARRON WI 54812 VANYO MOODY Gender - Capacity: M/F - 82 (715) 537-5700 RAYMOND WEISS 200 BELGRADE AVE STE 1 Low/High rate: 5,100/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: BARRON N MANKATO MN 56003 Initial License: 06/19/1984 PUBLIC FUNDING NEW BEGINNINGS OF BARRON COUNTY INC (0009905) NEW BEGINNINGS OF BARRON COUNTY INC Type: CBRF HCBS COMPLIANT (715) 736-1311 Class: AA 4 CORNELL AVENUE EMOTIONALLY DISTURBED/MENTAL RICE LAKE WI 54868 RENEE ANDERSON Gender - Capacity: M/F - 8 (715) 736-1311 RENEE ANDERSON 4 CORNELL AVE Low/High rate: 3,300/6,000 PUBLIC FUNDING County: BARRON RICE LAKE WI 54868 Initial License: 12/19/2002

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 3 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

NEW BEGINNINGS OF BARRON COUNTY INC (0009905) NEW BEGINNINGS OF BARRON COUNTY INC Type: CBRF HCBS COMPLIANT (715) 736-1311 Class: AA 4 CORNELL AVENUE EMOTIONALLY DISTURBED/MENTAL RICE LAKE WI 54868 RENEE ANDERSON Gender - Capacity: M/F - 8 (715) 736-1311 RENEE ANDERSON 4 CORNELL AVE Low/High rate: 3,300/6,000 PUBLIC FUNDING County: BARRON RICE LAKE WI 54868 Initial License: 12/19/2002 NORTHWOOD GABLES (0018291) CARE MANAGEMENT LLC Type: CBRF HCBS COMPLIANT (715) 820-0383 Class: AA 1464 21ST AVENUE DEVELOPMENTALLY DISABLED RICE LAKE WI 54868 STEPHEN BANT Gender - Capacity: M/F - 8 (715) 234-9415 MICHELLE AMBORN 1814 AUGUSTA STREET Low/High rate: 2,790/7,750 EMOTIONALLY DISTURBED/MENTAL County: BARRON RICE LAKE WI 54868 Initial License: 01/22/2021 OUR HOUSE RICE LAKE ASSISTED CARE (0013421) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 415 E SOUTH ST ADVANCED AGED RICE LAKE WI 54868 LORI NARDIN Gender - Capacity: M/F - 20 (715) 236-7211 LAUREN METHENY 4350 156TH STREET Low/High rate: 3,975/4,345 IRREVERSIBLE DEMENTIA/ALZHEIM County: BARRON CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING OUR HOUSE RICE LAKE MEMORY CARE (0013426) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 413 E SOUTH ST ADVANCED AGED RICE LAKE WI 54868 LORI NARDIN Gender - Capacity: M/F - 24 (715) 736-0347 LAUREN METHENY 4350 156TH STREET Low/High rate: 4,625/4,625 IRREVERSIBLE DEMENTIA/ALZHEIM County: BARRON CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING VISTA PRAIRIE AT BRENTWOOD (0018417) Vista Prairie at Brentwood LLC Type: CBRF ADVANCED AGED (952) 837-0540 Class: CNA 633 CAMERON ROAD IRREVERSIBLE DEMENTIA/ALZHEIM RICE LAKE WI 54868 James Bettendorf Gender - Capacity: M/F - 20 (715) 736-7400 TRICIA NELSON 7100 Northland Circle North Low/High rate: 5,120/6,000 PHYSICALLY DISABLED County: BARRON Brooklyn Park MN 55428 Initial License: 03/11/2021 PUBLIC FUNDING TERMINALLY ILL WOODSTONE SENIOR LIVING CBRF (0012947) WELCOME HOME HEALTH CARE INC Type: CBRF HCBS COMPLIANT (320) 587-0005 Class: CNA 950 BEAR PAW AVENUE ADVANCED AGED RICE LAKE WI 54868 JACOB WORK Gender - Capacity: M/F - 39 (715) 736-6060 AUDREY LOISELLE PO BOX 172 Low/High rate: 4,887/6,887 IRREVERSIBLE DEMENTIA/ALZHEIM County: BARRON HUTCHINSON MN 55350 Initial License: 09/18/2009 OAKS AT NORTHERN LIGHTS (THE) (0012705) NORTHERN LIGHTS SERVICES Type: CBRF ADVANCED AGED (715) 373-5621 Class: CNA 702 BRATLEY DR IRREVERSIBLE DEMENTIA/ALZHEIM WASHBURN WI 54891 Amanda Brilla Gender - Capacity: M/F - 17 (715) 373-5621 AMANDA BRILLA 706 BRATLEY DR Low/High rate: 3,500/3,900 PUBLIC FUNDING County: BAYFIELD WASHBURN WI 54891 Initial License: 03/20/2009 Association Approval: LeadingAge Wisconsin WILLOW MANOR (0013334) WILLOW MANOR INC Type: CBRF ADVANCED AGED (715) 372-5005 Class: CS 68290 N DISTRICT ST PUBLIC FUNDING IRON RIVER WI 54847 PEGGY HIPSHER Gender - Capacity: M/F - 8 (715) 372-5005 PEGGY HIPSHER 68290 N DISTRICT ST Low/High rate: 3,000/4,100 County: BAYFIELD IRON RIVER WI 54847 Initial License: 09/01/2010 ACS GREEN BAY (0011996) ACS CLINICAL SERVICES LLC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 223-0017 Class: AS 2670 UNIVERSITY AVE CORRECTIONAL CLIENTS GREEN BAY WI 54311 KAYFIA GORDON Gender - Capacity: M/F - 20 (920) 469-2569 KAYFIA GORDON 2670 UNIVERSITY AVE Low/High rate: 2,374/2,629 County: BROWN GREEN BAY WI 54311 Initial License: 08/31/2007 ALLOUEZ PARKSIDE VILLAGE 2 (0015841) ASSISTED LIVING BY HILLCREST Type: CBRF ADVANCED AGED (920) 784-0195 Class: CNA 1901 LIBAL STREET IRREVERSIBLE DEMENTIA/ALZHEIM GREEN BAY WI 54301 AMY DORO Gender - Capacity: M/F - 64 (920) 432-3322 ASHLEY VAN DINTER 1889 COMMERCE DRIVE Low/High rate: 4,900/5,500 PHYSICALLY DISABLED County: BROWN DEPERE WI 54115 Initial License: 10/29/2015 PUBLIC FUNDING TERMINALLY ILL ALLOUEZ PARKSIDE VILLAGE 1 LLC (0017630) ASSISTED LIVING BY HILLCREST Type: CBRF HCBS COMPLIANT (920) 850-5235 Class: CNA 1901 LIBAL ST ADVANCED AGED GREEN BAY WI 54301 ASHLEY VAN DINTER Gender - Capacity: M/F - 65 (920) 430-8500 ASHLEY VAN DINTER 1889 COMMERCE DR Low/High rate: 3,500/8,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DEPERE WI 54115 Initial License: 07/11/2019 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 4 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ALPHA SENIOR CONCEPTS (0013802) AVIEW SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 366-6221 Class: CNA 2723 LINEVILLE RD ADVANCED AGED GREEN BAY WI 54313 JENNIE LINDNER Gender - Capacity: M/F - 50 (920) 393-4531 JENNIE LINDNER 2723 LINEVILLE RD Low/High rate: 4,500/6,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN GREEN BAY WI 54313 Initial License: 10/07/2011 PHYSICALLY DISABLED TERMINALLY ILL ALPHA SENIOR CONCEPTS SUAMICO (0015697) ALPHA SENIOR CONCEPTS SUAMICO INC Type: CBRF HCBS COMPLIANT (920) 770-4601 Class: CNA 13320 VELP AVE ADVANCED AGED SUAMICO WI 54313 COURTNEY WEIGELT Gender - Capacity: M/F - 25 (920) 770-4601 COURTNEY WEIGELT 13320 VELP AVE Low/High rate: 4,600/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN SUAMICO WI 54173 Initial License: 07/29/2015 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ANGELS TOUCH ASSISTED LIVING (0017307) CB HEALTHCARE MANAGEMENT LLC Type: CBRF ADVANCED AGED (262) 312-8355 Class: CNA 400 ANGELS TOUCH CT EMOTIONALLY DISTURBED/MENTAL DE PERE WI 54115 DOLORES MANTIK Gender - Capacity: M/F - 22 (920) 336-9137 DOLORES MANTIK 400 ANGELS TOUCH CT Low/High rate: 5,000/5,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DE PERE WI 54115 Initial License: 08/14/2018 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ANGELS TOUCH ASSISTED LIVING (0017309) CB HEALTHCARE MANAGEMENT LLC Type: CBRF ADVANCED AGED (262) 312-8355 Class: CNA 394 ANGELS TOUCH CT EMOTIONALLY DISTURBED/MENTAL DE PERE WI 54115 DOLORES MANTIK Gender - Capacity: M/F - 22 (920) 336-9137 DOLORES MANTIK 394 ANGELS TOUCH CT Low/High rate: 5,000/5,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DE PERE WI 54115 Initial License: 08/14/2018 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ANGELS TOUCH ASSISTED LIVING (0017308) CB HEALTHCARE MANAGEMENT LLC Type: CBRF ADVANCED AGED (262) 312-8355 Class: CNA 1350 ANGELS TOUCH CT EMOTIONALLY DISTURBED/MENTAL DE PERE WI 54115 DOLORES MANTIK Gender - Capacity: M/F - 22 (920) 336-9137 DOLORES MANTIK 1350 ANGELS TOUCH CT Low/High rate: 5,000/5,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DE PERE WI 54115 Initial License: 08/14/2018 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ANNAS HOUSE ASSISTED LIVING 2 (0017500) IVY LANE LLC Type: CBRF HCBS COMPLIANT (262) 914-0246 Class: CNA 5449 CTY HWY K ADVANCED AGED NEW FRANKEN WI 54229 ANDREW DOPUCH Gender - Capacity: M/F - 36 (920) 866-2903 ANDY DOPUCH 25615 91ST STREET Low/High rate: 3,700/5,500 ALCOHOL/DRUG DEPENDENT County: BROWN SALEM WI 53168 Initial License: 04/15/2019 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL ANNAS HOUSE ASSISTED LIVING I (0017499) IVY LANE LLC Type: CBRF HCBS COMPLIANT (262) 914-0246 Class: CNA 5449 CTY HWY K ADVANCED AGED NEW FRANKEN WI 54229 ANDREW DOPUCH Gender - Capacity: M/F - 16 (920) 866-2903 ANDY DOPUCH 25615 91ST STREET Low/High rate: 3,700/5,500 ALCOHOL/DRUG DEPENDENT County: BROWN SALEM WI 53168 Initial License: 04/15/2019 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 5 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

AUTUMNS PROMISE ASSISTED LIVING LLC (0014514) GINGER K LUTZ Type: CBRF HCBS COMPLIANT (920) 615-5523 Class: CNA 1700 SPARTAN RD ADVANCED AGED GREEN BAY WI 54311 GINGER LUTZ Gender - Capacity: M/F - 30 (920) 465-1181 NICOLE SILTA 436 MCAULIFFE HEIGHTS TRAIL Low/High rate: 4,701/58,768 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN GREEN BAY WI 54311 Initial License: 06/06/2013 PHYSICALLY DISABLED TERMINALLY ILL AUTUMNS PROMISE ASSISTED LIVING LLC (0014514) GINGER K LUTZ Type: CBRF HCBS COMPLIANT (920) 615-5523 Class: CNA 1700 SPARTAN RD ADVANCED AGED GREEN BAY WI 54311 GINGER LUTZ Gender - Capacity: M/F - 30 (920) 465-1181 NICOLE SILTA 436 MCAULIFFE HEIGHTS TRAIL Low/High rate: 4,701/58,768 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN GREEN BAY WI 54311 Initial License: 06/06/2013 PHYSICALLY DISABLED TERMINALLY ILL BAY HARBOR ASSISTED LIVING SUAMICO I (0015398) BAY HARBOR ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (608) 371-9292 Class: CNA 3136 LONGVIEW LN ALCOHOL/DRUG DEPENDENT SUAMICO WI 54173 DELORES MOYER Gender - Capacity: - 20 (920) 434-8650 DELORES MOYER PO BOX 190 Low/High rate: 4,500/7,000 DEVELOPMENTALLY DISABLED County: BROWN SUAMICO WI 54173 Initial License: 03/01/2016 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BAY HARBOR II (0008920) HARBOR SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 621-5935 Class: CNA 3136 LONGVIEW LN BLDG B ADVANCED AGED SUAMICO WI 54173 DEBRA TEGGE Gender - Capacity: M/F - 14 (920) 662-0470 DELORES MOYER PO BOX 190 Low/High rate: 3,900/6,900 ALCOHOL/DRUG DEPENDENT County: BROWN SUAMICO WI 54173 Initial License: 12/30/1999 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED BISHOPS COURT (410493) ALPHA FAMILY LIM PARTNERSHIP Type: CBRF ADVANCED AGED (920) 337-2450 Class: CNA 289 E ST JOSEPH ST IRREVERSIBLE DEMENTIA/ALZHEIM GREEN BAY WI 54301 ELISABETH BEYER Gender - Capacity: M/F - 69 (920) 435-2729 ELISABETH BEYER 289 E ST JOSEPH ST Low/High rate: 3,200/4,500 PUBLIC FUNDING County: BROWN GREEN BAY WI 54301 Initial License: 09/23/1997 TERMINALLY ILL WAIVER CERTIFIED INDEPENDENT C BORNEMANN CBRF SOUTH (0015320) BORNEMANN CBRF S OPERATING COMPANY LL Type: CBRF HCBS COMPLIANT (716) 748-7888 Class: CNA 1853 MILLS ST ADVANCED AGED GREEN BAY WI 54302 LEXIE BAUM Gender - Capacity: M/F - 20 (920) 468-3110 JASON L WILLIAMS 226 BORNEMANN ST Low/High rate: 4,350/5,270 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN GREEN BAY WI 54302 Initial License: 12/01/2014 PHYSICALLY DISABLED TERMINALLY ILL BROWN CO COMMUNITY TREATMENT CENTER BAY HAV BROWN COUNTY COMMUNITY TREATMENT CEN Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 391-4700 Class: CS 3150 GERSHWIN DR DEVELOPMENTALLY DISABLED GREEN BAY WI 54311 ANISSA SMITH Gender - Capacity: M/F - 15 (920) 391-4701 ANISSA SMITH 3150 GERSHWIN DR Low/High rate: 6,000/20,160 EMOTIONALLY DISTURBED/MENTAL County: BROWN GREEN BAY WI 54311 Initial License: 12/13/2013 BUFFLEHEAD LANE (0016562) INNOVATIVE SERVICES INC Type: CBRF HCBS COMPLIANT (920) 431-0962 Class: CNA 2084 BUFFLEHEAD LN ADVANCED AGED GREEN BAY WI 54311 JILL ROWLAND Gender - Capacity: M/F - 8 (920) 465-9410 STEPHANIE ANDERSON 2321 SAN LUIS PLACE Low/High rate: 4,954/5,472 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54304 Initial License: 06/06/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 6 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BURGOYNE COURT I (0016750) INNOVATIVE SERVICES INC Type: CBRF HCBS COMPLIANT (920) 431-0962 Class: CNA 1725 BURGOYNE COURT ADVANCED AGED DE PERE WI 54115 JILL ROWLAND Gender - Capacity: M/F - 8 (920) 337-6266 STEPHANIE ANDERSON 2321 SAN LUIS PLACE Low/High rate: 5,048/6,084 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54304 Initial License: 09/25/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY BURGOYNE COURT II (0016751) INNOVATIVE SERVICES INC Type: CBRF HCBS COMPLIANT (920) 431-0962 Class: CNA 1743 BURGOYNE COURT ADVANCED AGED DE PERE WI 54115 JILL ROWLAND Gender - Capacity: M/F - 8 (920) 337-6266 STEPHANIE ANDERSON 2321 SAN LUIS PLACE Low/High rate: 5,048/6,084 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54304 Initial License: 09/25/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CARATON COMMONS 1 (0017259) SENIOR OPPORTUNITY FUND OPERATIONS I LL Type: CBRF HCBS COMPLIANT (678) 445-2300 Class: CNA 1550 ARCADIAN LN ADVANCED AGED DE PERE WI 54115 JACKIE DEY Gender - Capacity: M/F - 20 (920) 339-0601 JENNALEE LUNDQUIST 1889 COMMERCE DRIVE Low/High rate: 2,600/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DE PERE WI 54115 Initial License: 05/01/2019 PHYSICALLY DISABLED TERMINALLY ILL CARATON COMMONS 2 (0017258) SENIOR OPPORTUNITY FUND OPERATIONS I LL Type: CBRF HCBS COMPLIANT (678) 445-2300 Class: CNA 1500 ARCADIAN LN ADVANCED AGED DE PERE WI 54115 JACKIE DEY Gender - Capacity: M/F - 20 (920) 339-0601 JENNALEE LUNDQUIST 1889 COMMERCE DR Low/High rate: 2,600/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DE PERE WI 54115 Initial License: 05/01/2019 PHYSICALLY DISABLED TERMINALLY ILL CARATON COMMONS 3 (0017257) SENIOR OPPORTUNITY FUND OPERATIONS I LL Type: CBRF HCBS COMPLIANT (678) 445-2300 Class: CNA 1525 ARCADIAN LN ADVANCED AGED DE PERE WI 54115 JACKIE DEY Gender - Capacity: M/F - 20 (920) 339-0601 JENNALEE LUNDQUIST 1889 COMMERCE DR Low/High rate: 2,600/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DE PERE WI 54115 Initial License: 05/01/2019 PHYSICALLY DISABLED TERMINALLY ILL CARATON COMMONS GREEN BAY 1 (0017255) SENIOR OPPORTUNITY FUND OPERATIONS I LL Type: CBRF HCBS COMPLIANT (678) 445-2300 Class: CNA 653 WOODSIDE RD ADVANCED AGED GREEN BAY WI 54311 JACKIE DEY Gender - Capacity: M/F - 15 (920) 406-7600 JENNALEE LUNDQUIST 1889 COMMERCE DR Low/High rate: 2,500/4,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DE PERE WI 54115 Initial License: 05/01/2019 PHYSICALLY DISABLED TERMINALLY ILL CARATON COMMONS GREEN BAY 2 (0017256) SENIOR OPPORTUNITY FUND OPERATIONS I LL Type: CBRF HCBS COMPLIANT (678) 445-2300 Class: CNA 655 WOODSIDE RD ADVANCED AGED GREEN BAY WI 54311 JACKIE DEY Gender - Capacity: M/F - 15 (920) 406-7600 JENNALEE LUNDQUIST 1889 COMMERCE DR Low/High rate: 2,500/4,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN DE PERE WI 54115 Initial License: 05/01/2019 PHYSICALLY DISABLED TERMINALLY ILL CARDINAL RIDGE RESIDENTIAL CARE (0010029) CARDINAL RIDGE RESIDENTIAL CARE Type: CBRF HCBS COMPLIANT (920) 434-9600 Class: CNA 713 CARDINAL LANE ADVANCED AGED GREEN BAY WI 54313 ALLIE NEWKIRK Gender - Capacity: M/F - 26 (920) 434-9600 ALLIE NEWKIRK PO BOX 11966 Low/High rate: 3,995/5,295 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54307-1966 Initial License: 04/01/2003 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING CARRINGTON ASSISTED LIVING (0018090) ARMH LEASECO 1 LLC Type: CBRF HCBS COMPLIANT (858) 500-6793 Class: CNA 2626 FINGER ROAD ADVANCED AGED GREEN BAY WI 54302 KAREN SCHACHT Gender - Capacity: M/F - 20 (920) 469-2606 NICOLE SLAYTON 328 NATURE PI Low/High rate: 4,295/6,295 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN JOHNSON CREEK WI 53038 Initial License: 05/27/2020

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 7 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CENTURY RIDGE OF GREEN BAY I (0014023) CENTURY RIDGE OF GREEN BAY INC Type: CBRF HCBS COMPLIANT (920) 468-2520 Class: CNA 2498 BLUESTONE PL ADVANCED AGED GREEN BAY WI 54311 JILL BAETEN Gender - Capacity: M/F - 20 (920) 468-2520 JENNIFER CRAWFORD 2498 BLUESTONE PL Low/High rate: 2,400/3,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN GREEN BAY WI 54311 Initial License: 05/10/2012 PUBLIC FUNDING TERMINALLY ILL CENTURY RIDGE OF GREEN BAY II (0014024) CENTURY RIDGE OF GREEN BAY INC Type: CBRF HCBS COMPLIANT (920) 468-2520 Class: CNA 2510 BLUESTONE PL ADVANCED AGED GREEN BAY WI 54311 JILL BAETEN Gender - Capacity: M/F - 20 (920) 468-2520 JENNIFER CRAWFORD 2510 BLUESTONE PL Low/High rate: 2,400/3,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN GREEN BAY WI 54311 Initial License: 05/10/2012 PUBLIC FUNDING TERMINALLY ILL CFAA INC (0015405) CFAA INC Type: CBRF HCBS COMPLIANT (920) 432-8119 Class: CNA 1308 S NORWOOD AVE ADVANCED AGED GREEN BAY WI 54304 RACHEL CHVALA Gender - Capacity: - 31 (920) 432-8119 RACHEL CHVALA 1308 S NORWOOD AVE Low/High rate: 2,900/3,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN GREEN BAY WI 54304 Initial License: 01/29/2015 PHYSICALLY DISABLED PUBLIC FUNDING CLARITY CARE BERNARD ON HOFFMAN (0008949) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 898 E HOFFMAN RD ADVANCED AGED GREEN BAY WI 54301 BARB SALEMI Gender - Capacity: F - 6 (920) 338-1569 RACHEL KLITZKE 424 WASHINGTON AVE Low/High rate: 4,309/5,794 DEVELOPMENTALLY DISABLED County: BROWN OSHKOSH WI 54901 Initial License: 06/23/2000 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CLARITY CARE MANETTE (0018275) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: ANA 1796 CABINET MAKER COURT ADVANCED AGED GREEN BAY WI 54303 BARB SALEMI Gender - Capacity: F - 5 (920) 236-6560 RACHEL KLITZKE 424 WEST WASHINGTON AVENUE Low/High rate: 6,087/6,134 DEVELOPMENTALLY DISABLED County: BROWN OSHKOSH WI 54901 Initial License: 11/01/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY CLARITY CARE SHAWANO AVENUE APARTMENTS (41044 CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 1297 SHAWANO AVE DEVELOPMENTALLY DISABLED GREEN BAY WI 54303 BARB SALEMI Gender - Capacity: M/F - 7 (920) 490-4581 RACHEL KLITZKE 424 WASHINGTON AVE Low/High rate: 5,154/5,154 EMOTIONALLY DISTURBED/MENTAL County: BROWN OSHKOSH WI 54901 Initial License: 01/29/1996 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY COTTONWOOD MANOR ASSISTED LIVING (0015625) GREEN BAY SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 499-8838 Class: CNA 1450 S MILITARY AVE ADVANCED AGED GREEN BAY WI 54304 LEE JOHNSON Gender - Capacity: M/F - 35 (920) 499-8838 DAVE MERKLEY 1675 E RIVERSIDE DR STE 150 Low/High rate: 3,500/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN EAGLE ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL COUNTRY VILLA ASSISTED LIVING PULASKI (0016105) COUNTRY VILLA ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 422-4629 Class: CNA 830 CREST DR ADVANCED AGED PULASKI WI 54162 CHAD READER Gender - Capacity: M/F - 38 (920) 422-4629 MELISSA BARKER W2015 INDUSTRIAL DR Low/High rate: 4,000/7,000 EMOTIONALLY DISTURBED/MENTAL County: BROWN KAUKAUNA WI 54130 Initial License: 04/25/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL COURTYARD AT BELLEVUE (THE) (0017364) BELLEVUE ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (312) 462-4462 Class: CNA 1600 HOFFMAN ROAD IRREVERSIBLE DEMENTIA/ALZHEIM BELLEVUE WI 54311 THOMAS OSTROM Gender - Capacity: M/F - 48 LINDSAY FREDERICK 101 N WACKER DR STE 616 Low/High rate: 3,000/9,000 PHYSICALLY DISABLED County: BROWN CHICAGO IL 60606 Initial License: 02/15/2019 TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 8 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

DURHAM (0014170) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 2671-2673 DURHAM RD ADVANCED AGED GREEN BAY WI 54311 BARB SALEMI Gender - Capacity: M/F - 6 (920) 884-3160 RACHEL KLITZKE 424 WASHINGTON AVE Low/High rate: 5,480/5,938 DEVELOPMENTALLY DISABLED County: BROWN OSHKOSH WI 54901 Initial License: 08/13/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY EMERALD BAY MEMORY CARE (0016808) SCAL OF HOBART LLC Type: CBRF ADVANCED AGED (920) 574-3833 Class: CNA 650 CENTENNIAL CENTRE BLVD IRREVERSIBLE DEMENTIA/ALZHEIM HOBART WI 54155 KATHERINE TEGEN Gender - Capacity: M/F - 24 (920) 544-5041 SHAWN RAMIREZ 5555 GRANDE MARKET DRIVE STE A Low/High rate: 5,000/6,000 PHYSICALLY DISABLED County: BROWN APPLETON WI 54913 Initial License: 09/26/2017 TERMINALLY ILL GRANCARE GARDENS (0012738) DONALD & DONNA ZUNKER Type: CBRF ADVANCED AGED 1551 DOUSMAN ST (920) 494-4525 Class: CNA GREEN BAY WI 54303 BRENDA CARPENTER Gender - Capacity: M/F - 20 (920) 494-3050 BRENDA LEE CARPENTER 1555 DOUSMAN ST Low/High rate: 3,475/5,150 County: BROWN GREEN BAY WI 54303 Initial License: 05/01/2009 Association Approval: LeadingAge Wisconsin HAMPTON MANOR (410565) ADULT CARE LIVING OF NE WI LLC Type: CBRF HCBS COMPLIANT (920) 434-9666 Class: AS 1265 ROCKWELL RD ADVANCED AGED GREEN BAY WI 54313 JANE NEWLUN Gender - Capacity: M/F - 8 (920) 434-9666 JANE NEWLUN 1265 ROCKWELL RD Low/High rate: 2,235/3,500 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54313 Initial License: 11/03/1998 HIL FOX RUN (0016365) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (920) 499-2688 Class: CNA 1744 BURGOYNE CT DEVELOPMENTALLY DISABLED DEPERE WI 54115 ASHLEY WILLIAMS Gender - Capacity: M/F - 8 (920) 983-9592 DAWN ZIEMENDORF 1249 RUSSETT COURT Low/High rate: 6,303/6,303 PUBLIC FUNDING County: BROWN GREEN BAY WI 54313 Initial License: 03/20/2017 HIL MAPLE CREST (0011664) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 825 GOLDEN EAGLE CT DEVELOPMENTALLY DISABLED PULASKI WI 54162 ASHLEY WILLIAMS Gender - Capacity: M/F - 6 (920) 822-1571 DAWN MCABEE 1249 RUSSETT COURT Low/High rate: 6,472/6,472 PUBLIC FUNDING County: BROWN GREEN BAY WI 54313 Initial License: 10/02/2006 HIL MEADOW RIDGE (0016346) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (920) 499-2688 Class: CNA 2657 SANDRA ROSE LANE DEVELOPMENTALLY DISABLED NEW FRANKEN WI 54229 ASHLEY WILLIAMS Gender - Capacity: M/F - 8 LISA SCHWENDEMAN 1249 RUSSETT COURT Low/High rate: 6,607/6,607 PHYSICALLY DISABLED County: BROWN GREEN BAY WI 54313 Initial License: 02/27/2017 PUBLIC FUNDING TRAUMATIC BRAIN INJURY HIL ORIOLE (0013593) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 503 PLATTEN ST DEVELOPMENTALLY DISABLED GREEN BAY WI 54303 ASHLEY WILLIAMS Gender - Capacity: M/F - 6 (920) 857-9718 DAWN ZIEMENDORF 1249 RUSSETT COURT Low/High rate: 6,242/6,242 PUBLIC FUNDING County: BROWN GREEN BAY WI 54313 Initial License: 12/21/2010 TRAUMATIC BRAIN INJURY HIL ROCKWOOD HEIGHTS (0009812) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 2744 ROCKWOOD HEIGHTS DEVELOPMENTALLY DISABLED GREEN BAY WI 54313 ASHLEY WILLIAMS Gender - Capacity: M/F - 7 (920) 662-1203 DAWN MCABEE 1249 RUSSETT COURT Low/High rate: 6,205/6,205 PHYSICALLY DISABLED County: BROWN GREEN BAY WI 54313 Initial License: 01/01/2002 PUBLIC FUNDING TRAUMATIC BRAIN INJURY HIL WESTPLAIN (0014177) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AA 335-339 WESTPLAIN DR DEVELOPMENTALLY DISABLED GREEN BAY WI 54303 ASHLEY WILLIAMS Gender - Capacity: M/F - 5 (920) 857-3734 LISA SCHWENDEMAN 1249 RUSSETT COURT Low/High rate: 9,380/9,380 EMOTIONALLY DISTURBED/MENTAL County: BROWN GREEN BAY WI 54313 Initial License: 06/13/2012 PUBLIC FUNDING TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 9 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

INNOVATIVE SERVICES INC DIVERSION FACILITY (001320 INNOVATIVE SERVICES INC Type: CBRF ADVANCED AGED (920) 431-0962 Class: CNA 1311 N DANZ AVE ALCOHOL/DRUG DEPENDENT GREEN BAY WI 54302 JILL ROWLAND Gender - Capacity: M/F - 20 (920) 435-3750 STEPHANIE ANDERSON 2321 SAN LUIS PLACE Low/High rate: 3,330/3,330 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54304 Initial License: 09/22/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING LAFRANK CBRF (0014492) COMPASS DEVELOPMENT LLC Type: CBRF HCBS COMPLIANT (920) 405-9010 Class: AS 1713 FRANK ST DEVELOPMENTALLY DISABLED GREEN BAY WI 54304 KEVIN LAPOINTE Gender - Capacity: M/F - 5 (920) 405-0712 KEVIN LAPOINTE 2029 TRUE LN Low/High rate: 5,300/5,850 PUBLIC FUNDING County: BROWN GREEN BAY WI 54304 Initial License: 05/13/2013 TRAUMATIC BRAIN INJURY LIBAL STREET HOME (0011145) INNOVATIVE SERVICES INC Type: CBRF HCBS COMPLIANT (920) 431-0962 Class: CNA 3500 LIBAL ST ADVANCED AGED GREEN BAY WI 54301 JILL ROWLAND Gender - Capacity: M/F - 5 (920) 347-4624 STEPHANIE ANDERSON 2321 SAN LUIS PLACE Low/High rate: 5,331/5,963 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54304 Initial License: 12/16/2005 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY LSS NORTH VIEW HOUSE (410213) LUTHERAN SOC SERV OF WI & UPPER MI INC Type: CBRF HCBS COMPLIANT (920) 730-1326 Class: AA 2517-19 N VIEW CT EMOTIONALLY DISTURBED/MENTAL GREEN BAY WI 54303 PAULA UPP Gender - Capacity: M/F - 8 (920) 494-5454 DENNIS HANSON 3003 N RICHMOND ST Low/High rate: 5,152/5,152 PUBLIC FUNDING County: BROWN APPLETON WI 54911 Initial License: 12/08/1989 LSS PREBLE HOUSE (410202) LUTHERAN SOC SERV OF WI & UPPER MI INC Type: CBRF HCBS COMPLIANT (920) 730-1326 Class: AA 830-832 EDGEWOOD DR EMOTIONALLY DISTURBED/MENTAL GREEN BAY WI 54311 PAULA UPP Gender - Capacity: M/F - 8 (920) 465-9977 DENNIS HANSON 3003-A N RICHMOND ST Low/High rate: 5,152/5,152 PUBLIC FUNDING County: BROWN APPLETON WI 54911 Initial License: 11/06/1989 MARLA VISTA ASSISTED LIVING (0018100) ARMH LEASECO 1 LLC Type: CBRF HCBS COMPLIANT (858) 500-6793 Class: CNA 1006 NORTH MILITARY AVENUE ADVANCED AGED GREEN BAY WI 54303 KAREN SCHACHT Gender - Capacity: M/F - 40 (920) 499-1119 FRANCISCA HOLMES 328 NATURE PL Low/High rate: 4,295/6,295 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN JOHNSON CREEK WI 53038 Initial License: 05/27/2020 MARLA VISTA GARDENS (0018111) ARMH LEASECO 1 LLC Type: CBRF HCBS COMPLIANT (858) 500-6793 Class: CNA 1016 NORTH MILITARY AVENUE ADVANCED AGED GREEN BAY WI 54303 KAREN SCHACHT Gender - Capacity: M/F - 20 (920) 499-1119 FRANCISCA HOLMES 328 NATURE PL Low/High rate: 4,295/6,295 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN JOHNSON CREEK WI 53038 Initial License: 05/27/2020 MATTHEWS OF WRIGHTSTOWN (0014162) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 510 MEADOW LN ADVANCED AGED WRIGHTSTOWN WI 54180 THOMAS OSTROM Gender - Capacity: M/F - 16 (920) 532-0375 HEATHER HINTZ 101 N WACKER DR STE 616 Low/High rate: 3,000/6,000 EMOTIONALLY DISTURBED/MENTAL County: BROWN CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL NEW PERSPECTIVE-HOWARD (0016149) HOWARD OPS LLC Type: CBRF HCBS COMPLIANT (952) 241-8211 Class: CNA 2790 ELM TREE HILL ADVANCED AGED HOWARD WI 54313 DARIN DUVALL Gender - Capacity: - 60 (920) 489-8600 DARIN DUVALL 2790 ELM TREE HILL Low/High rate: 3,200/4,900 DEVELOPMENTALLY DISABLED County: BROWN HOWARD WI 54313 Initial License: 06/27/2016 IRREVERSIBLE DEMENTIA/ALZHEIM TERMINALLY ILL Association Approval: WALA

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 10 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

OAK PARK PLACE OF GREEN BAY (0016397) OAK PARK PLACE OF GREEN BAY LLC Type: CBRF ADVANCED AGED (608) 729-2981 Class: CNA 421 ERIE RD IRREVERSIBLE DEMENTIA/ALZHEIM GREEN BAY WI 54311 SCOTT FRANK Gender - Capacity: M/F - 45 (920) 301-4200 JOHN CORPUS 719 JUPITER DR Low/High rate: 4,650/5,850 PHYSICALLY DISABLED County: BROWN MADISON WI 53718 Initial License: 04/17/2017 TERMINALLY ILL OAKS FAM CARE CTR CARI HOUSE (410014) G & I OCHS INC DBA OAKS FAMILY CARE CENTE Type: CBRF HCBS COMPLIANT (920) 497-0194 Class: AA 1485 PLYMOUTH LN DEVELOPMENTALLY DISABLED GREEN BAY WI 54303 CYNDI GARBISCH Gender - Capacity: M - 6 (920) 497-2477 LISA WANEK 550 N MILITARY AVE #13 Low/High rate: 3,020/3,020 PUBLIC FUNDING County: BROWN GREEN BAY WI 54303 Initial License: 10/03/1980 OAKS FAM CARE CTR CHRISTIANA (410158) G & I OCHS INC DBA OAKS FAMILY CARE CENTE Type: CBRF HCBS COMPLIANT (920) 497-0194 Class: CS 1643 CHRISTIANA ST DEVELOPMENTALLY DISABLED GREEN BAY WI 54303 CYNTHIA GARBISCH Gender - Capacity: M - 8 (920) 499-8641 DAVID WICKMAN 550 N MILITARY AVE STE 13 Low/High rate: 3,245/3,245 PUBLIC FUNDING County: BROWN GREEN BAY WI 54303 Initial License: 07/01/1986 OAKS FAM CARE CTR DAMIAN HOUSE (410097) G & I OCHS INC DBA OAKS FAMILY CARE CENTE Type: CBRF HCBS COMPLIANT (920) 497-0194 Class: AS 1481 PLYMOUTH LANE DEVELOPMENTALLY DISABLED GREEN BAY WI 54303 CYNDI GARBISCH Gender - Capacity: F - 7 (920) 494-3804 LISA WANEK 550 N MILITARY AVE #13 Low/High rate: 3,387/3,387 PUBLIC FUNDING County: BROWN GREEN BAY WI 54303 Initial License: 10/02/1980 OAKS FAM CARE CTR GRANT ST (410174) G & I OCHS INC DBA OAKS FAMILY CARE CENTE Type: CBRF HCBS COMPLIANT (920) 497-0194 Class: CA 1527 GRANT ST DEVELOPMENTALLY DISABLED DE PERE WI 54115 CYNDI GARBISCH Gender - Capacity: M - 6 (920) 336-3155 CYNDI GARBISCH 550 N MILITARY AVE STE 13 Low/High rate: 3,105/4,489 PUBLIC FUNDING County: BROWN GREEN BAY WI 54303 Initial License: 12/09/1988 OAKS FAM CARE CTR OAKLAND HOUSE (410156) G & I OCHS INC DBA OAKS FAMILY CARE CENTE Type: CBRF HCBS COMPLIANT (920) 497-0194 Class: AA 126 N OAKLAND AVE DEVELOPMENTALLY DISABLED GREEN BAY WI 54303 CYNDI GARBISCH Gender - Capacity: M - 7 (920) 432-1555 CYNDI GARBISCH 550 N MILITARY AVE #13 Low/High rate: 3,291/3,695 PUBLIC FUNDING County: BROWN GREEN BAY WI 54303 Initial License: 09/01/1988 OUR PLACE (0009922) FAMILY SERVICES OF NE WIS INC Type: CBRF HCBS COMPLIANT (920) 436-6800 Class: AA 1501 N IRWIN ST EMOTIONALLY DISTURBED/MENTAL GREEN BAY WI 54302 TANA KOSS Gender - Capacity: M/F - 18 (920) 438-7146 KATIE RAPPEL 300 CROOKS ST Low/High rate: 3,010/3,333 PUBLIC FUNDING County: BROWN GREEN BAY WI 54301 Initial License: 12/17/2002 PATIENT PINES ASSISTED LIVING INC 1715 (0013896) TONI CARTER Type: CBRF HCBS COMPLIANT (920) 737-8664 Class: CNA 1715 WESTMINSTER DR ADVANCED AGED GREEN BAY WI 54302-5431 TONI CARTER Gender - Capacity: M/F - 8 (920) 884-2273 TONI CARTER 1715 WESTMINSTER DR Low/High rate: 3,000/5,900 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54302-5431 Initial License: 11/02/2011 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL PATIENT PINES ASSISTED LIVING INC 1721 (0013897) TONI CARTER Type: CBRF HCBS COMPLIANT (920) 737-8664 Class: CNA 1721 WESTMINSTER DR ADVANCED AGED GREEN BAY WI 54302-5431 TONI CARTER Gender - Capacity: M/F - 8 (920) 884-2273 TONI CARTER 1715 WESTMINSTER DR Low/High rate: 3,000/5,900 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54302 Initial License: 11/08/2011 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL REFLECTIONS AT MORAINE RIDGE (0016822) MORAINE RIDGE LLC Type: CBRF ADVANCED AGED (920) 468-3111 Class: CNA 2919 ST ANTHONY DR IRREVERSIBLE DEMENTIA/ALZHEIM GREEN BAY WI 54311 LORRIE RYCZEK Gender - Capacity: M/F - 30 (920) 468-3111 LORRIE RYCZEK 2919 ST ANTHONY DR Low/High rate: 5,000/5,200 TERMINALLY ILL County: BROWN GREEN BAY WI 54311 Initial License: 10/09/2017

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 11 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

RESIDENCE BY RENNES (0017321) RENNES ASSISTED LIVING CORP Type: CBRF ADVANCED AGED (715) 582-2258 Class: CNA 1150 LOIS ST IRREVERSIBLE DEMENTIA/ALZHEIM DE PERE WI 54115 MICHAEL MILLER Gender - Capacity: M/F - 26 (920) 983-5200 MICHAEL MILLER 1150 LOIS ST Low/High rate: 5,200/6,800 County: BROWN DE PERE WI 54115 Initial License: 08/29/2018 Association Approval: LeadingAge Wisconsin RIDGE POINTE CBRF (0012658) COMPASS DEVELOPMENT LLC Type: CBRF HCBS COMPLIANT (920) 405-9010 Class: CS 204 S ONEIDA ST DEVELOPMENTALLY DISABLED GREEN BAY WI 54303 KEVIN LAPOINTE Gender - Capacity: M/F - 5 (920) 884-3192 KEVIN LAPOINTE 2029 TRUE LN Low/High rate: 5,000/5,750,000 PUBLIC FUNDING County: BROWN GREEN BAY WI 54304 Initial License: 03/25/2009 TRAUMATIC BRAIN INJURY SAGE MEADOW DEPERE (0017590) A6 DE PERE LLC Type: CBRF HCBS COMPLIANT (312) 462-4462 Class: CNA 1880 SCHEURING ROAD ADVANCED AGED DE PERE WI 54115 THOMAS OSTROM Gender - Capacity: M/F - 44 (920) 338-3407 JAMIE MARTENS-MANNS 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN CHICAGO IL 60606 Initial License: 05/30/2019 TERMINALLY ILL SCANDINAVIAN COURT ASSISTED LIVING (0015623) DENMARK SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 863-5362 Class: CNA 346 SCANDINAVIAN CT ADVANCED AGED DENMARK WI 54208 LEE JOHNSON Gender - Capacity: M/F - 20 (920) 863-5362 DAVE MERKLEY 1675 E RIVERSIDE DR STE 150 Low/High rate: 2,407/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN EAGLE ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL SCHUMACHER HOUSE (0010929) INNOVATIVE SERVICES INC Type: CBRF HCBS COMPLIANT (920) 431-0962 Class: CNA 2831 FERNDALE DRIVE ADVANCED AGED GREEN BAY WI 54313 JILL ROWLAND Gender - Capacity: M/F - 5 (920) 497-9110 STEPHANIE ANDERSON 2321 SAN LUIS PLACE Low/High rate: 5,854/5,854 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54304 Initial License: 03/31/2005 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY SERVAIS POINTE CBRF (0013912) COMPASS DEVELOPMENT LLC Type: CBRF HCBS COMPLIANT (920) 405-9010 Class: CA 1398 SERVAIS ST DEVELOPMENTALLY DISABLED GREEN BAY WI 54304 KEVIN LAPOINTE Gender - Capacity: M/F - 5 (920) 884-2366 KEVIN LAPOINTE 2029 TRUE LANE Low/High rate: 4,700/5,400 PUBLIC FUNDING County: BROWN GREEN BAY WI 54304 Initial License: 10/10/2011 TRAUMATIC BRAIN INJURY SHERWOOD PLACE (0010552) PRODUCTIVE LIVING SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 831-3910 Class: AA 4893 FINGER RD DEVELOPMENTALLY DISABLED GREEN BAY WI 54311 JENNY MAYVILLE Gender - Capacity: M/F - 8 (920) 863-3665 JENNY MAYVILLE 619 N LYNNDALE DR Low/High rate: 6,037/6,037 EMOTIONALLY DISTURBED/MENTAL County: BROWN APPLETON WI 54914 Initial License: 06/15/2004 TRAUMATIC BRAIN INJURY VERLIN ROAD (0016454) INNOVATIVE SERVICES INC Type: CBRF HCBS COMPLIANT (920) 431-0962 Class: CNA 2149 VERLIN RD ADVANCED AGED GREEN BAY WI 54311 JILL ROWLAND Gender - Capacity: M/F - 8 (920) 465-4779 STEPHANIE ANDERSON 2321 SAN LUIS PLACE Low/High rate: 5,076/5,076 DEVELOPMENTALLY DISABLED County: BROWN GREEN BAY WI 54304 Initial License: 06/06/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY WOODSIDE MANOR I II III IV (410168) BAY AREA LUTHERAN HOMES INC Type: CBRF ADVANCED AGED (920) 499-1481 Class: CNA 1060 PILGRIM WAY IRREVERSIBLE DEMENTIA/ALZHEIM GREEN BAY WI 54304 SCOTT ROSS Gender - Capacity: M/F - 140 (920) 499-7560 JESSICA ATKINSON 1060 PILGRIM WAY Low/High rate: 3,000/5,750 PHYSICALLY DISABLED County: BROWN GREEN BAY WI 54304 Initial License: 09/12/1988 PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 12 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

WYNDEMERE ASPEN HOUSE (0016472) CSL- WYNDEMERE LLC Type: CBRF HCBS COMPLIANT (541) 636-3460 Class: CNA 3001 RIVERSIDE DR ADVANCED AGED GREEN BAY WI 54301 WILL FORSYTH Gender - Capacity: M/F - 20 (920) 337-9434 JENNIFER OWENS 1580 VALLEY RIVER DR STE 260 Low/High rate: 4,212/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN EUGENE OR 97401 Initial License: 02/15/2017 PUBLIC FUNDING WYNDEMERE BIRCH HOUSE (0016473) CSL WYNDEMERE LLC Type: CBRF HCBS COMPLIANT (541) 636-3460 Class: CNA 2999 RIVERSIDE DR ADVANCED AGED GREEN BAY WI 54301 WILL FORSYTH Gender - Capacity: M/F - 16 (920) 337-9434 JENNIFER OWENS 1580 VALLEY RIVER DR STE 260 Low/High rate: 4,305/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: BROWN EUGENE OR 97401 Initial License: 02/15/2017 PUBLIC FUNDING WYNDEMERE CEDAR HOUSE (0016474) CSL WYNDEMERE LLC Type: CBRF HCBS COMPLIANT (541) 636-3460 Class: CNA 2995 RIVERSIDE DR ADVANCED AGED GREEN BAY WI 54301 WILL FORSYTH Gender - Capacity: M/F - 14 (920) 337-9434 JENNIFER OWENS 360 E 10TH AVE STE 104 Low/High rate: 6,109/6,109 DEVELOPMENTALLY DISABLED County: BROWN EUGENE OR 97401 Initial License: 02/15/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED HILLVIEW SENIOR LIVING (0014061) AMERICAN LUTHERAN HOMES, INC Type: CBRF ADVANCED AGED (715) 926-4962 Class: CNA 210 MEMORIAL DRIVE PHYSICALLY DISABLED MONDOVI WI 54755 TONYA LISOWSKI Gender - Capacity: M/F - 38 (715) 926-4962 TONYA LISOWSKI 210 MEMORIAL DRIVE Low/High rate: 3,575/5,225 County: BUFFALO MONDOVI WI 54755 Initial License: 04/18/2012 Association Approval: LeadingAge Wisconsin HOMEPLACE OF MONDOVI (THE) (0016995) HOMEPLACE OF MONDOVI LLC (THE) Type: CBRF ADVANCED AGED (715) 644-2136 Class: CNA 158 E MAIN ST DEVELOPMENTALLY DISABLED MONDOVI WI 54755 KELLY ROHWEDDER Gender - Capacity: M/F - 10 (715) 926-4777 KELLY ROHWEDDER 225 E 4TH AVE Low/High rate: 4,250/4,550 IRREVERSIBLE DEMENTIA/ALZHEIM County: BUFFALO STANLEY WI 54768 Initial License: 02/06/2018 ST MICHAELS ASSISTED LIVING (0014018) ST. MICHAELS ASSISTED LIVING Type: CBRF HCBS COMPLIANT (608) 687-7721 Class: CNA 270 NORTH STREET ADVANCED AGED FOUNTAIN CITY WI 54629 TIFFANY OLSON Gender - Capacity: M/F - 30 (608) 687-7721 TIFFANY OLSON 270 NORTH STREET Low/High rate: 4,809/5,454 IRREVERSIBLE DEMENTIA/ALZHEIM County: BUFFALO FOUNTAIN CITY WI 54629 Initial License: 04/17/2012 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL ST MICHAELS ASSISTED LIVING (0014018) ST. MICHAELS ASSISTED LIVING Type: CBRF HCBS COMPLIANT (608) 687-7721 Class: CNA 270 NORTH STREET ADVANCED AGED FOUNTAIN CITY WI 54629 TIFFANY OLSON Gender - Capacity: M/F - 30 (608) 687-7721 TIFFANY OLSON 270 NORTH STREET Low/High rate: 4,809/5,454 IRREVERSIBLE DEMENTIA/ALZHEIM County: BUFFALO FOUNTAIN CITY WI 54629 Initial License: 04/17/2012 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL ST MICHAELS ASSISTED LIVING (0014018) ST. MICHAELS ASSISTED LIVING Type: CBRF HCBS COMPLIANT (608) 687-7721 Class: CNA 270 NORTH STREET ADVANCED AGED FOUNTAIN CITY WI 54629 TIFFANY OLSON Gender - Capacity: M/F - 30 (608) 687-7721 TIFFANY OLSON 270 NORTH STREET Low/High rate: 4,809/5,454 IRREVERSIBLE DEMENTIA/ALZHEIM County: BUFFALO FOUNTAIN CITY WI 54629 Initial License: 04/17/2012 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: WALA COUNTRYSIDE ACRES ASSISTED LIVING LLC (0013811) SARA/THERESA STADLER/ROSSOW Type: CBRF ADVANCED AGED (715) 866-4411 Class: CA 5788 COUNTY ROAD C DEVELOPMENTALLY DISABLED WEBSTER WI 54893 THERESA ROSSOW Gender - Capacity: M/F - 8 (715) 866-4411 THERESA ROSSOW 5788 COUNTY ROAD C Low/High rate: 1,500/8,000 PHYSICALLY DISABLED County: BURNETT WEBSTER WI 54893 Initial License: 10/14/2011 PUBLIC FUNDING TRAUMATIC BRAIN INJURY KAPES LAKESIDE ASSISTED LIVING & MEMORY CARE (00 KAPES LAKESIDE ASSISTED LIVING and MEMOR Type: CBRF ADVANCED AGED (715) 371-0548 Class: CNA 23926 4TH AVE DEVELOPMENTALLY DISABLED SIREN WI 54872 SARA STADLER Gender - Capacity: M/F - 50 (715) 349-5273 SARA STADLER 23926 4TH AVE Low/High rate: 2,000/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: BURNETT SIREN WI 54872 Initial License: 09/25/2017 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 13 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SHADY KNOLL HOME (0010021) GSP OF GRANTSBURG INC Type: CBRF HCBS COMPLIANT (715) 463-2587 Class: AA 240 W BROADWAY AVE ADVANCED AGED GRANTSBURG WI 54840 GREGORY PEER Gender - Capacity: M/F - 8 (715) 463-5425 GREGORY PEER P O BOX 468 Low/High rate: 2,025/2,609 DEVELOPMENTALLY DISABLED County: BURNETT GRANTSBURG WI 54840 Initial License: 04/04/2003 PUBLIC FUNDING ACS CLINICAL SERVICES LLC APPLETON (0014907) ACS CLINICAL SERVICES LLC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 223-0017 Class: AS 2 BRIGHTON CIRCLE CORRECTIONAL CLIENTS APPLETON WI 54915 KAYFIA GORDON Gender - Capacity: F - 10 (920) 364-9335 KAYFIA GORDON 2 BRIGHTON CIRCLE Low/High rate: 3,500/3,500 PREGNANT WOMEN/COUNSELLING County: CALUMET APPLETON WI 54915 Initial License: 03/13/2015 BRILLION WEST HAVEN (0012537) BRILLION SENIOR MANAGEMENT LLC Type: CBRF HCBS COMPLIANT (920) 784-0195 Class: CNA 220 ACHIEVEMENT DR ADVANCED AGED BRILLION WI 54110 JACKIE DEY Gender - Capacity: M/F - 60 (920) 756-9100 JACKIE DEY 220 ACHIEVEMENT DR Low/High rate: 3,150/4,635 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET BRILLION WI 54110 Initial License: 10/28/2008 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL CARE PARTNERS KAUKAUNA (0017854) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA W5219 AMY AVE ADVANCED AGED KAUKAUNA WI 54130 JASON LINDEMANN Gender - Capacity: M/F - 56 HEATH BUYER PO BOX 3006 Low/High rate: 5,200/6,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET OSHKOSH WI 54903 Initial License: 11/18/2019 PHYSICALLY DISABLED TERMINALLY ILL CARING HANDS ASSISTED LIVING (0016710) CARING HANDS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 999-4473 Class: CNA 2514 WISCONSIN AVE ADVANCED AGED NEW HOLSTEIN WI 53061 THOMAS M STEFFEN Gender - Capacity: M/F - 24 (920) 827-2525 JEANNE KLEIN N8301 CTY G Low/High rate: 3,250/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET ST CLOUD WI 53079 Initial License: 09/08/2017 CENTURY RIDGE I (0016779) SHANTHI LIVING LLC Type: CBRF HCBS COMPLIANT (312) 388-0330 Class: CNA 533 E CALUMET STREET ADVANCED AGED CHILTON WI 53014 ANIK SHAH Gender - Capacity: M/F - 21 (920) 849-2640 ERICA RACINE 10129 PACIFIC AVE Low/High rate: 3,900/5,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET FRANKLIN PARK IL 60131 Initial License: 09/15/2017 TERMINALLY ILL CENTURY RIDGE II (0016780) SHANTHI LIVING LLC Type: CBRF HCBS COMPLIANT (312) 388-0330 Class: CNA 531 E CALUMET ST ADVANCED AGED CHILTON WI 53014 ANIK SHAH Gender - Capacity: M/F - 21 (920) 849-2640 ERICA RACINE 10129 PACIFIC AVE Low/High rate: 3,900/5,300 DEVELOPMENTALLY DISABLED County: CALUMET FRANKLIN PARK IL 60131 Initial License: 09/15/2017 IRREVERSIBLE DEMENTIA/ALZHEIM CENTURY RIDGE III (0016781) SHANTHI LIVING LLC Type: CBRF HCBS COMPLIANT (312) 388-0330 Class: CNA 535 E CALUMET STREET ADVANCED AGED CHILTON WI 53014 ANIK SHAH Gender - Capacity: M/F - 21 (920) 849-2640 ERICA RACINE 10129 PACIFIC AVE Low/High rate: 3,900/5,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET FRANKLIN PARK IL 60131 Initial License: 09/18/2017 TERMINALLY ILL DARBOY ASSISTED LIVING (0015847) B A ISRAEL LLC Type: CBRF HCBS COMPLIANT (773) 416-8534 Class: CNA N9520 SILVER CT ADVANCED AGED APPLETON WI 54915 BRIGHT AMUDOAGHAN Gender - Capacity: M/F - 8 (920) 832-9290 MICHELE PACKETT N9520 SILVER CT Low/High rate: 4,000/5,000 DEVELOPMENTALLY DISABLED County: CALUMET APPLETON WI 54915 Initial License: 03/03/2016 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY GARDENS OF FOUNTAIN WAY (THE) (0010205) GARDENS OF FOUNTAIN WAY LLC Type: CBRF HCBS COMPLIANT (920) 739-0111 Class: CNA 1050 FOUNTAIN WAY ADVANCED AGED MENASHA WI 54952 ANN COYLE Gender - Capacity: M/F - 23 (920) 993-9980 TANYA CLARK 1050 FOUNTAIN WAY Low/High rate: 3,000/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET MENASHA WI 54952 Initial License: 11/25/2003 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 14 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

GARDENS OF FOUNTAIN WAY (THE) (0010205) GARDENS OF FOUNTAIN WAY LLC Type: CBRF HCBS COMPLIANT (920) 739-0111 Class: CNA 1050 FOUNTAIN WAY ADVANCED AGED MENASHA WI 54952 ANN COYLE Gender - Capacity: M/F - 23 (920) 993-9980 TANYA CLARK 1050 FOUNTAIN WAY Low/High rate: 3,000/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET MENASHA WI 54952 Initial License: 11/25/2003 PUBLIC FUNDING GARDENS OF FOUNTAIN WAY (THE) (0010205) GARDENS OF FOUNTAIN WAY LLC Type: CBRF HCBS COMPLIANT (920) 739-0111 Class: CNA 1050 FOUNTAIN WAY ADVANCED AGED MENASHA WI 54952 ANN COYLE Gender - Capacity: M/F - 23 (920) 993-9980 TANYA CLARK 1050 FOUNTAIN WAY Low/High rate: 3,000/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET MENASHA WI 54952 Initial License: 11/25/2003 PUBLIC FUNDING GARDENS OF FOUNTAIN WAY (THE) (0010205) GARDENS OF FOUNTAIN WAY LLC Type: CBRF HCBS COMPLIANT (920) 739-0111 Class: CNA 1050 FOUNTAIN WAY ADVANCED AGED MENASHA WI 54952 ANN COYLE Gender - Capacity: M/F - 23 (920) 993-9980 TANYA CLARK 1050 FOUNTAIN WAY Low/High rate: 3,000/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET MENASHA WI 54952 Initial License: 11/25/2003 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin GARROW VILLA (410344) CITY OF BRILLION HOUSING AUTHORITY Type: CBRF HCBS COMPLIANT (920) 756-3041 Class: CNA 210 S PARKWAY DR ADVANCED AGED BRILLION WI 54110 APRIL SCHRUBBE Gender - Capacity: M/F - 20 (920) 756-3389 APRIL SCHRUBBE 210 S PARKWAY DR Low/High rate: 4,500/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET BRILLION WI 54110 Initial License: 03/01/1994 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL OAK CREEK ASSISTED LIVING - KIEL (0012113) P & J OAKS LLC - KIEL Type: CBRF HCBS COMPLIANT (920) 973-0855 Class: CNA 1237 TEKLA PL ADVANCED AGED KIEL WI 53042 PAM ROSSANO Gender - Capacity: M/F - 20 (920) 894-3222 PAM ROSSANO 1237 TEKLA PL Low/High rate: 3,400/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: CALUMET KIEL WI 53042 Initial License: 11/09/2007 PHYSICALLY DISABLED TERMINALLY ILL OAK PARK PLACE OF MENASHA (0015983) OAK PARK PLACE OF MENASHA LLC Type: CBRF ADVANCED AGED (920) 702-0000 Class: CNA 2205 MIDWAY ROAD IRREVERSIBLE DEMENTIA/ALZHEIM MENASHA WI 54952 SCOTT FRANK Gender - Capacity: M/F - 55 (920) 702-0000 AMANDA WOODWARD 719 JUPITER DR Low/High rate: 4,475/6,725 PHYSICALLY DISABLED County: CALUMET MADISON WI 53718 Initial License: 03/01/2016 TERMINALLY ILL OAK PARK PLACE OF MENASHA (0015983) OAK PARK PLACE OF MENASHA LLC Type: CBRF ADVANCED AGED (920) 702-0000 Class: CNA 2205 MIDWAY ROAD IRREVERSIBLE DEMENTIA/ALZHEIM MENASHA WI 54952 SCOTT FRANK Gender - Capacity: M/F - 55 (920) 702-0000 AMANDA WOODWARD 719 JUPITER DR Low/High rate: 4,475/6,725 PHYSICALLY DISABLED County: CALUMET MADISON WI 53718 Initial License: 03/01/2016 TERMINALLY ILL WILLOWPARK PLACE (0014651) WILLOWPARK AID OPCO LLC Type: CBRF ADVANCED AGED 1706 HOOVER ST (415) 995-5135 Class: CNA NEW HOLSTEIN WI 53061 ATTN: LEGAL DEPARTMENT Gender - Capacity: M/F - 50 (920) 898-5553 MARSHA PRANGE 330 N WABASH AVE STE 3700 Low/High rate: 2,523/5,851 County: CALUMET CHICAGO IL 60611 Initial License: 07/11/2013 AGGIES COUNTRY LIVING LLC (0015795) AGGIES COUNTRY LIVING LLC Type: CBRF HCBS COMPLIANT (715) 559-3625 Class: CNA 14135 150TH AVENUE ADVANCED AGED BLOOMER WI 54724 SHEENA HARINGS Gender - Capacity: M/F - 13 (715) 559-3625 SHEENA HARINGS 14135 150TH AVENUE Low/High rate: 4,000/6,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA BLOOMER WI 54724 Initial License: 10/12/2015 BROTOLOC NORTH NEW HOPE II (0016522) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA 133 W ELM STREET ALCOHOL/DRUG DEPENDENT CHIPPEWA FALLS WI 54729 LINDSAY FARRELL GOVEK Gender - Capacity: M/F - 8 (715) 720-1551 LINDSAY FARRELL GOVEK 2710 N TOWN HALL ROAD Low/High rate: 5,723/6,448 DEVELOPMENTALLY DISABLED County: CHIPPEWA EAU CLAIRE WI 54703 Initial License: 06/14/2017 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING BURPO CBRF (510291) RITA & WILLIAM BURPO Type: CBRF HCBS COMPLIANT (715) 492-1199 Class: AA 26101 275TH ST DEVELOPMENTALLY DISABLED HOLCOMBE WI 54745 RITA BURPO Gender - Capacity: F - 7 (715) 595-6008 RITA BURPO 26101 275TH ST Low/High rate: 1,402/1,402 County: CHIPPEWA HOLCOMBE WI 54745-4506 Initial License: 06/15/1989 Association Approval: WALA *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 15 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CARE PARTNERS ASSISTED LIVING BLOOMER II (001257 CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 406 B PRIDDY STREET ADVANCED AGED BLOOMER WI 54724 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 568-4009 TRACY MARQUARDT P O BOX 3006 Low/High rate: 3,200/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA OSHKOSH WI 54903 Initial License: 10/09/2008 PHYSICALLY DISABLED TERMINALLY ILL CHIPPEWA VALLEY GROUP HOME (0016181) HAILEY SIKORA Type: CBRF ADVANCED AGED (715) 226-0516 Class: AS 1022 1ST AVE DEVELOPMENTALLY DISABLED CHIPPEWA FALLS WI 54729 HAILEY SIKORA Gender - Capacity: M/F - 8 (715) 726-1820 HAILEY SIKORA 1022 1ST AVENUE Low/High rate: 53/200 EMOTIONALLY DISTURBED/MENTAL County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 08/12/2016 TRAUMATIC BRAIN INJURY COUNTRY TERRACE - BLOOMER (0011080) COUNTRY TERRACE OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 406 PRIDDY ST ADVANCED AGED BLOOMER WI 54724 JASON LINDEMANN Gender - Capacity: M/F - 17 (715) 568-4009 TRACY MARQUARDT P O BOX 3006 Low/High rate: 2,702/3,952 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA OSHKOSH WI 54903 Initial License: 08/12/2005 PHYSICALLY DISABLED TERMINALLY ILL COUNTRY TERRACE STANLEY (0012898) COUNTRY TERRACE OF WISCONSIN LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 804 PINE ST ADVANCED AGED STANLEY WI 54768 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 644-3444 LAKEN TIBBITS P O BOX 3006 Low/High rate: 3,400/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA OSHKOSH WI 54903 Initial License: 08/01/2009 PHYSICALLY DISABLED TERMINALLY ILL GRATUS AT EVERGREEN (0017680) MIDWEST GRATUS INC Type: CBRF HCBS COMPLIANT (715) 861-5320 Class: CNA 1126 & 1128 EVERGREEN LN ADVANCED AGED CHIPPEWA FALLS WI 54729 SANDRA JOHNSON-ERICKSEN Gender - Capacity: M/F - 8 (715) 861-5320 EBONY ROBERTSON PO BOX 159 Low/High rate: 3,965/9,900 ALCOHOL/DRUG DEPENDENT County: CHIPPEWA MENOMONIE WI 54751 Initial License: 10/01/2019 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY GRATUS AT SELAH (0017681) MIDWEST GRATUS INC Type: CBRF HCBS COMPLIANT (715) 861-5320 Class: CNA 421 FRENETTE DR ADVANCED AGED CHIPPEWA FALLS WI 54729 SANDRA JOHNSON-ERICKSEN Gender - Capacity: M/F - 24 (715) 861-7772 MARILYN MATULA PO BOX 159 Low/High rate: 3,965/9,900 ALCOHOL/DRUG DEPENDENT County: CHIPPEWA MENOMONIE WI 54751 Initial License: 10/01/2019 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY HOMEPLACE (THE) (0012212) JILL TALLMAN Type: CBRF HCBS COMPLIANT (715) 644-2136 Class: CNA 225 E 4TH AVE ADVANCED AGED STANLEY WI 54768 KELLY ROHWEDDER Gender - Capacity: M/F - 33 (715) 644-2136 KELLY ROHWEDDER 225 E 4TH AVE Low/High rate: 4,550/4,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA STANLEY WI 54768 Initial License: 05/01/2008 LAKE HALLIE MEMORY CARE (0014577) HALLIE ASSISTED LIVING PARTNERS Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM (715) 523-0030 Class: CNA 4407 124TH STREET PUBLIC FUNDING CHIPPEWA FALLS WI 54729 ANA HINES Gender - Capacity: M/F - 77 (715) 738-0011 BRAD GOEMAN 4407 124TH STREET Low/High rate: 4,600/13,500 County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 04/04/2013 LINDEN HOUSE (0015234) LINDEN HOUSE LLC Type: CBRF HCBS COMPLIANT (715) 505-2391 Class: AA 603 BAY STREET DEVELOPMENTALLY DISABLED CHIPPEWA FALLS WI 54729 KELLY HAYES Gender - Capacity: M/F - 8 (715) 861-3516 KELLY HAYES 603 BAY STREET Low/High rate: 90/300 PUBLIC FUNDING County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 09/14/2015

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 16 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MEADOWBROOK AT BLOOMER (0017937) BLOOMER NURSING AND REHAB LLC Type: CBRF HCBS COMPLIANT (847) 942-7575 Class: CNA 1900 PRIDDY STREET ADVANCED AGED BLOOMER WI 54724 BRENDA BOWE Gender - Capacity: M/F - 8 (715) 568-2503 ANNA HENCK 1900 PRIDDY STREET Low/High rate: 3,500/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA BLOOMER WI 54724 Initial License: 12/01/2019 NEW HOPE HALLIE INC (0013009) NEW HOPE HALLIE INC Type: CBRF EMOTIONALLY DISTURBED/MENTAL 10875 40TH AVENUE (715) 720-7360 Class: AA CHIPPEWA FALLS WI 54729 KAREN BLACK Gender - Capacity: M/F - 8 (715) 720-7360 KAREN BLACK 2111 WHEATON STREET Low/High rate: 3,900/3,900 County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 10/22/2009 OUR HOUSE CHIPPEWA FALLS ASSISTED CARE (0013432 KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 115 MARRS ST ADVANCED AGED CHIPPEWA FALLS WI 54729 LORI NARDIN Gender - Capacity: M/F - 24 (715) 723-6840 AMANDA HANSON 4350 156TH STREEET Low/High rate: 4,375/4,475 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING OUR HOUSE CHIPPEWA FALLS MEMORY CARE (0013435 KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 105 MARRS ST ADVANCED AGED CHIPPEWA FALLS WI 54729 LORI NARDIN Gender - Capacity: M/F - 24 (715) 723-6037 KARRI WOLD 4350 156TH STREET Low/High rate: 4,830/4,930 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING RUTLEDGE HOME (0011783) WOLFTEVER HEALTHCARE LLC Type: CBRF HCBS COMPLIANT (715) 723-5566 Class: CNA 300 BRIDGEWATER AVE ADVANCED AGED CHIPPEWA FALLS WI 54729 BROOKE ZAHNLE Gender - Capacity: M/F - 63 (715) 723-5566 BROOKE ZAHNLE 300 BRIDGEWATER AVE Low/High rate: 3,250/4,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 04/03/2007 PHYSICALLY DISABLED RUTLEDGE HOME (0011783) WOLFTEVER HEALTHCARE LLC Type: CBRF HCBS COMPLIANT (715) 723-5566 Class: CNA 300 BRIDGEWATER AVE ADVANCED AGED CHIPPEWA FALLS WI 54729 BROOKE ZAHNLE Gender - Capacity: M/F - 63 (715) 723-5566 BROOKE ZAHNLE 300 BRIDGEWATER AVE Low/High rate: 3,250/4,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 04/03/2007 PHYSICALLY DISABLED RUTLEDGE HOME (0011783) WOLFTEVER HEALTHCARE LLC Type: CBRF HCBS COMPLIANT (715) 723-5566 Class: CNA 300 BRIDGEWATER AVE ADVANCED AGED CHIPPEWA FALLS WI 54729 BROOKE ZAHNLE Gender - Capacity: M/F - 63 (715) 723-5566 BROOKE ZAHNLE 300 BRIDGEWATER AVE Low/High rate: 3,250/4,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 04/03/2007 PHYSICALLY DISABLED Association Approval: LeadingAge Wisconsin SCOTT AND ALLIES HOME SWEET HOME LLC (0017646) SCOTT AND ALLIES HOME SWEET HOME LLC Type: CBRF HCBS COMPLIANT (715) 559-1373 Class: CNA 13362 98TH AVE ADVANCED AGED CHIPPEWA FALLS WI 54729 SCOTT REITER Gender - Capacity: M/F - 13 (715) 726-1113 ALLIE REITER 13362 98TH AVE Low/High rate: 2,800/6,000 PHYSICALLY DISABLED County: CHIPPEWA CHIPPEWA FALLS WI 54729 Initial License: 05/31/2019 TRAUMATIC BRAIN INJURY COUNTRY TERRACE ABBOTSFORD (0014129) COUNTRY TERRACE OF WI INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 100 S 4TH AVE ADVANCED AGED ABBOTSFORD WI 54405 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 223-2182 MICHELLE KRAMER P O BOX 3006 Low/High rate: 3,000/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: CLARK OSHKOSH WI 54903 Initial License: 04/18/2012 PHYSICALLY DISABLED TERMINALLY ILL HOMEPLACE OF DORCHESTER LLC CBRF (0013040) HOMEPLACE OF DORCHESTER LLC Type: CBRF HCBS COMPLIANT (715) 644-2137 Class: CNA 155 N 3RD ST ADVANCED AGED DORCHESTER WI 54425 KELLY ROHWEDDER Gender - Capacity: M/F - 14 (715) 654-6009 DEANNA MORRIS 225 E 4TH AVE Low/High rate: 3,850/4,550 DEVELOPMENTALLY DISABLED County: CLARK STANLEY WI 54768 Initial License: 05/07/2010 IRREVERSIBLE DEMENTIA/ALZHEIM PABICHS RESIDENTIAL FACILITY INC (510067) PABICHS RESIDENTIAL FACILITY INC Type: CBRF HCBS COMPLIANT (715) 267-6212 Class: AA 311 W HUNT ST DEVELOPMENTALLY DISABLED GREENWOOD WI 54437 ROBERTA PABICH Gender - Capacity: M/F - 8 (715) 267-7410 ROBERTA PABICH 601 STEVEN AVENUE Low/High rate: 2,267/8,000 PUBLIC FUNDING County: CLARK GREENWOOD WI 54437 Initial License: 03/01/1980 Association Approval: WALA

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 17 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

RIVERSIDE ASSISTED LIVING (0016757) RIVERSIDE ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (715) 937-2941 Class: CNA 1210 W 4TH ST IRREVERSIBLE DEMENTIA/ALZHEIM NEILLSVILLE WI 54456 KATI KUNHART Gender - Capacity: M/F - 17 (715) 743-2828 KATI KUNHART 1210 W 4TH ST Low/High rate: 3,000/9,000 County: CLARK NEILLSVILLE WI 54456 Initial License: 07/01/2017 TURNER INTEGRITY CARE LLC (0017493) TURNER INTEGRITY CARE LLC Type: CBRF HCBS COMPLIANT (715) 491-0919 Class: CNA 104 SODERBERG DR ADVANCED AGED THORP WI 54771 GERALD TURNER Gender - Capacity: M/F - 15 (715) 491-0919 AMANDA KARLEN N4687 CTY RD G Low/High rate: 3,300/4,700 DEVELOPMENTALLY DISABLED County: CLARK GILMAN WI 54433 Initial License: 07/10/2019 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL WOODLAND CARE CBRF (0014104) CLARK COUNTY HEALTH CARE CENTER Type: CBRF DEVELOPMENTALLY DISABLED (715) 229-2172 Class: CA W4266 COUNTY HIGHWAY X EMOTIONALLY DISTURBED/MENTAL OWEN WI 54460 ANGELA GRESCHNER Gender - Capacity: M/F - 8 (715) 229-2172 JANE SCHMITZ W4266 COUNTY HIGHWAY X Low/High rate: 5,800/9,300 PUBLIC FUNDING County: CLARK OWEN WI 54460 Initial License: 05/25/2012 Association Approval: LeadingAge Wisconsin AT HOME AGAIN COLUMBUS MEMORY CARE (0016591) HOME AGAIN ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 712-1517 Class: CNA 110 STUART STREET ADVANCED AGED COLUMBUS WI 53590 MELISSA OCONNOR Gender - Capacity: M/F - 12 (920) 623-9833 MELISSA OCONNOR 110 STUART STREET Low/High rate: 3,500/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA COLUMBUS WI 53590 Initial License: 03/09/2017 PHYSICALLY DISABLED TERMINALLY ILL AT HOME AGAIN MEMORY CARE RIO (0017005) A&J SENIOR CARE LLC Type: CBRF ADVANCED AGED (920) 996-6430 Class: CNA 403 LOWVILLE ROAD DEVELOPMENTALLY DISABLED RIO WI 53960 ALEXANDRA HASSELBERGER Gender - Capacity: M/F - 8 (920) 992-6430 ALEXANDRA HASSELBERGER 405 LOWVILLE ROAD Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA RIO WI 53960 Initial License: 06/15/2018 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL AT HOME AGAIN RIO (0016559) A&J SENIOR CARE LLC Type: CBRF HCBS COMPLIANT (920) 992-6430 Class: CNA 405 LOWVILLE RD ADVANCED AGED RIO WI 53960 ALEXANDRA HASSELBERGER Gender - Capacity: M/F - 16 (920) 992-6430 ALEXANDRA HASSELBERGER 405 LOWVILLE RD Low/High rate: 2,700/4,500 DEVELOPMENTALLY DISABLED County: COLUMBIA RIO WI 53960 Initial License: 03/07/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL CBL INC DBA THE REMINGTON HOUSE (0008879) CBL INC Type: CBRF HCBS COMPLIANT (608) 297-7012 Class: CNA 113 INDUSTRIAL DR ADVANCED AGED PARDEEVILLE WI 53954 JEAN KOCH Gender - Capacity: M/F - 20 (608) 429-4443 JEAN KOCH 113 INDUSTRIAL DR Low/High rate: 3,080/3,410 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA PARDEEVILLE WI 53954 Initial License: 01/01/2000 PUBLIC FUNDING HAMILTON PARK PLACE (0015335) THERAPEUTIC ASSISTED LIVING OPERATIONS L Type: CBRF HCBS COMPLIANT (920) 207-3550 Class: CNA 2525 HAMILTON STREET ADVANCED AGED PORTAGE WI 53901 Stoltz Laura Gender - Capacity: M/F - 24 (608) 742-7888 LAURA STOLTZ 402 FIRST STREET Low/High rate: 3,695/6,695 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA RANDOM LAKE WI 53075 Initial License: 12/26/2014 PHYSICALLY DISABLED PUBLIC FUNDING HAVEN HILLS (0016343) BACK IN LODI LLC Type: CBRF ADVANCED AGED (608) 575-7221 Class: CNA 215 DALE DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM LODI WI 53555 MAGGIE ROBERTS Gender - Capacity: M/F - 24 (608) 592-0394 MAGGIE ROBERTS 215 DALE DRIVE Low/High rate: 3,500/7,000 PHYSICALLY DISABLED County: COLUMBIA LODI WI 53555 Initial License: 08/17/2016 PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 18 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LAKE PLACE GROUP HOME (110023) THE ARC GREATER COLUMBIA COUNTY Type: CBRF HCBS COMPLIANT (608) 742-0260 Class: CS 105 LAKE RD DEVELOPMENTALLY DISABLED PORTAGE WI 53901 JULIE BRIGGS Gender - Capacity: M/F - 8 (608) 742-4746 JULIE BRIGGS 105 Lake Rd. Low/High rate: 2,112/2,112 County: COLUMBIA PORTAGE WI 53901 Initial License: 01/01/1981 LARSON HOUSE (0015679) LARSON HOUSE PLATINUM LLC Type: CBRF HCBS COMPLIANT (414) 940-6608 Class: CNA 550 RIVER RD ADVANCED AGED COLUMBUS WI 53925 JOHN TERESINSKI Gender - Capacity: M/F - 36 (920) 623-5810 Melissa Bloomhuff 2448 S 102nd street Suite #305 Low/High rate: 3,000/4,450 DEVELOPMENTALLY DISABLED County: COLUMBIA West Allis WI 53227 Initial License: 09/01/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL LARSON HOUSE SOUTH (0016818) LARSON HOUSE PLATINUM LLC Type: CBRF ADVANCED AGED (414) 940-6608 Class: CNA 550 RIVER ROAD DEVELOPMENTALLY DISABLED COLUMBUS WI 53925 JOHN TERESINSKI Gender - Capacity: M/F - 28 (920) 623-5810 Melissa Bloomhuff 2448 S 102nd Street #305 Low/High rate: 3,500/4,800 EMOTIONALLY DISTURBED/MENTAL County: COLUMBIA WEST ALLIS WI 53227 Initial License: 11/01/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL MEADOWS OF FALL RIVER CBRF (THE) (0016760) MEADOWS OF FALL RIVER LLC (THE) Type: CBRF HCBS COMPLIANT (920) 484-6171 Class: CNA 101 HOMETOWN AVE ADVANCED AGED FALL RIVER WI 53932 Robert Simonson Gender - Capacity: M/F - 18 (920) 484-6171 Green Marilyn 2850 MONARCH CT Low/High rate: 3,000/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA ALTOONA WI 54720 Initial License: 09/05/2017 PHYSICALLY DISABLED OUR HOUSE LODI ASSISTED CARE (0013382) KEYSTONE LODI LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 121 SECOND STREET ADVANCED AGED LODI WI 53555 LORI NARDIN Gender - Capacity: M/F - 16 (608) 592-7433 JAN KLEIST 4350 156th ST Low/High rate: 3,600/3,950 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING OUR HOUSE PORTAGE ASSISTED CARE (0013665) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 2876 VILLAGE RD ADVANCED AGED PORTAGE WI 53901 LORI NARDIN Gender - Capacity: M/F - 18 (608) 742-4626 DAWN KOEPPEL 4350 156th ST. Low/High rate: 3,650/4,150 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA CHIPPEWA FALLS WI 54729 Initial License: 04/15/2011 PUBLIC FUNDING OUR HOUSE WISCONSIN DELLS ASSISTED CARE (001338 KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 1954 STATE RD 23 ADVANCED AGED WISCONSIN DELLS WI 53965 LORI NARDIN Gender - Capacity: M/F - 20 (608) 253-3404 Jaclyn Schlict 4350 156th ST Low/High rate: 3,875/3,925 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING OUR HOUSE WISCONSIN DELLS MEMORY CARE (001338 KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 1950 STATE ROAD 23 ADVANCED AGED WISCONSIN DELLS WI 53965 LORI NARDIN Gender - Capacity: M/F - 20 (608) 253-7901 JACLYN SCHOMMER 4350 156th St. Low/High rate: 4,075/4,125 IRREVERSIBLE DEMENTIA/ALZHEIM County: COLUMBIA CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING RIVERS-BARABOO (THE) (0018332) ELDER CARE CONSULTING LLC Type: CBRF HCBS COMPLIANT (507) 361-3495 Class: CNA 601 LATTON LANE ADVANCED AGED PORTAGE WI 53901 MAGGIE ROBERTS Gender - Capacity: M/F - 14 (608) 566-1500 MAGGIE ROBERTS 601 LATTON LANE Low/High rate: 3,000/6,500 EMOTIONALLY DISTURBED/MENTAL County: COLUMBIA PORTAGE WI 53901 Initial License: 12/28/2020 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL RIVERS-FOX (THE) (0018330) ELDER CARE CONSULTING Type: CBRF HCBS COMPLIANT (507) 361-3495 Class: CNA 611 EAST ALBERT ST ADVANCED AGED PORTAGE WI 53901 MAGGIE ROBERTS Gender - Capacity: M/F - 20 (608) 566-1500 MAGGIE ROBERTS 611 E ALBERT STREET Low/High rate: 3,000/6,500 EMOTIONALLY DISTURBED/MENTAL County: COLUMBIA PORTAGE WI 53901 Initial License: 12/28/2020 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 19 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

RIVERS-WISCONSIN (THE) (0018327) ELDER CARE CONSULTING Type: CBRF HCBS COMPLIANT (507) 361-3495 Class: CNA 621 LATTON LANE ADVANCED AGED PORTAGE WI 53901 MAGGIE ROBERTS Gender - Capacity: M/F - 16 (608) 566-1500 MAGGIE ROBERTS 621 LATTON LANE Low/High rate: 3,000/6,500 EMOTIONALLY DISTURBED/MENTAL County: COLUMBIA PORTAGE WI 53901 Initial License: 12/28/2020 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL ROWAN TRAIL (0015147) THE ARC GREATER COLUMBIA COUNTY Type: CBRF HCBS COMPLIANT (608) 742-0260 Class: CNA 237 W SEWARD STREET DEVELOPMENTALLY DISABLED POYNETTE WI 53955 JULIE BRIGGS Gender - Capacity: M/F - 8 (608) 635-2887 JULIE BRIGGS 711 E COOK STREET SUITE 202 Low/High rate: 3,371/7,000 PHYSICALLY DISABLED County: COLUMBIA PORTAGE WI 53901 Initial License: 12/01/2014 BLUFF HAVEN ASSISTED LIVING (0012823) PRAIRIE MEMORIAL HOUSING LLC Type: CBRF ADVANCED AGED (608) 326-3200 Class: CNA 720 S FREMONT ST PUBLIC FUNDING PRAIRIE DU CHIEN WI 53821 ALESHA ERDENBERGER Gender - Capacity: M/F - 20 (608) 326-8472 Dana Cota 720 S FREMONT ST Low/High rate: 3,910/5,618 County: CRAWFORD PRAIRIE DU CHIEN WI 53821 Initial License: 08/10/2009 Association Approval: LeadingAge Wisconsin KNAPP HOME CASS STREET (0018137) LORI KNAPP INC Type: CBRF HCBS COMPLIANT (608) 326-0434 Class: CNA 216 WEST CASS STREET ADVANCED AGED PRAIRIE DU CHIEN WI 53821 DAMON FRIE Gender - Capacity: M/F - 5 (608) 326-2843 LYNN JENKINS 106 SOUTH BEAUMONT ROAD Low/High rate: 3,550/5,877 DEVELOPMENTALLY DISABLED County: CRAWFORD PRAIRIE DU CHIEN WI 53821 Initial License: 07/01/2020 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY ALL SAINTS ASSISTED LIVING CENTER INC (0016266) ELDERSPAN MANAGEMENT LLC Type: CBRF ADVANCED AGED (608) 243-8800 Class: CNA 519 COMMERCE DR IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53719 DARLA ARMSTRONG Gender - Capacity: M/F - 63 (608) 827-2990 HEIDI STRINGHAM 2445 DARWIN RD STE 109 Low/High rate: 5,850/7,200 PHYSICALLY DISABLED County: DANE MADISON WI 53704 Initial License: 08/16/2016 TERMINALLY ILL ARC DAYTON ST (110328) ARC COMMUNITY SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 278-2300 Class: AA 2009 E DAYTON ST CORRECTIONAL CLIENTS MADISON WI 53704 KAREN D KINSEY Gender - Capacity: F - 13 (608) 241-7616 JAN BATTLE 2001 W BELTLINE HWY STE 102 Low/High rate: 3,466/3,940 County: DANE MADISON WI 53713 Initial License: 01/15/1992 ARC HOUSE (110002) ARC COMMUNITY SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 278-2300 Class: AA 202 N PATERSON ST CORRECTIONAL CLIENTS MADISON WI 53703 KAREN KINSEY Gender - Capacity: F - 15 (608) 283-6430 Colleen Carroll 2001 W BELTLINE HWY STE 102 Low/High rate: 3,355/3,355 County: DANE MADISON WI 53713 Initial License: 03/31/1981 ARC MATERNAL & INFANT PROGRAM (110391) ARC COMMUNITY SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 278-2300 Class: AA 4202 MONONA DR CORRECTIONAL CLIENTS MADISON WI 53716 KAREN KINSEY Gender - Capacity: F - 12 (608) 223-9033 LINDA VAN TOL 2001 W BELTLINE HWY STE 102 Low/High rate: 3,940/5,250 PUBLIC FUNDING County: DANE MADISON WI 53713 Initial License: 02/01/1994 ASHWABAY HOUSE (THE) (0009535) FOUNTAINHEAD GROUP INC Type: CBRF HCBS COMPLIANT (608) 347-0366 Class: CNA 7310 ASHWABAY LANE ADVANCED AGED MADISON WI 53719 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 276-5883 RUTH POLACEK PO BOX 46010 Low/High rate: 3,500/10,000 EMOTIONALLY DISTURBED/MENTAL County: DANE MADISON WI 53744 Initial License: 01/08/2002 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY AT HOME AGAIN WAUNAKEE MEMORY CARE (0016885) HOME AGAIN ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 712-1517 Class: CNA 1120 CONNERY COVE ADVANCED AGED WAUNAKEE WI 53597 MARTY OCONNOR Gender - Capacity: M/F - 12 (608) 712-1517 MELISSA OCONNOR 3120 EDMONTON DR STE 300 Low/High rate: 5,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE SUN PRAIRIE WI 53590 Initial License: 11/03/2017 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 20 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ATTIC ANGEL PLACE (0017124) ATTIC ANGEL PLACE Type: CBRF HCBS COMPLIANT (608) 662-8842 Class: CNA 8301 OLD SAUK RD ADVANCED AGED MIDDLETON WI 53562 DEREK BUCKLEY Gender - Capacity: M/F - 66 (608) 662-8821 DEREK BUCKLEY 8301 OLD SAUK RD Low/High rate: 8,882/11,710 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MIDDLETON WI 53562 Initial License: 01/01/2019 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: LeadingAge Wisconsin ATTIC CORRECTIONAL TREATMENT CENTER (110047) ATTIC CORRECTIONAL SERVICES INC Type: CBRF CORRECTIONAL CLIENTS 4117 DWIGHT DR (608) 223-0017 Class: AA MADISON WI 53704 TODD VIETH Gender - Capacity: M - 19 (608) 244-1891 VICKI TREBIAN PO BOX 7370 Low/High rate: 2,280/2,280 County: DANE MADISON WI 53707 Initial License: 12/01/1979 ATTIC CORRECTIONAL TREATMENT CENTER (110047) ATTIC CORRECTIONAL SERVICES INC Type: CBRF CORRECTIONAL CLIENTS 4117 DWIGHT DR (608) 223-0017 Class: AA MADISON WI 53704 TODD VIETH Gender - Capacity: M - 19 (608) 244-1891 VICKI TREBIAN PO BOX 7370 Low/High rate: 2,280/2,280 County: DANE MADISON WI 53707 Initial License: 12/01/1979 AVALON ASSISTED LIVING COMMUNITY 700 (0011915) MADISON ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (541) 686-1119 Class: CNA 2879 FISH HATCHERY RD IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53713 Nancy Thomas Gender - Capacity: M/F - 23 (608) 520-1568 Nancy Thomas 2879 FISH HATCHERY RD Low/High rate: 2,595/4,495 TERMINALLY ILL County: DANE MADISON WI 53713 Initial License: 05/22/2007 AZURA MEMORY CARE OF STOUGHTON (0013404) AZURA STOUGHTON LLC Type: CBRF HCBS COMPLIANT (608) 836-5070 Class: CNA 1221 East MAIN ST ADVANCED AGED STOUGHTON WI 53589 JILL KREIDER Gender - Capacity: M/F - 29 (608) 873-8333 TRACY STANELLE 1233 N MAYFAIR RD STE 301 Low/High rate: 4,900/7,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MILWAUKEE WI 53226 Initial License: 08/15/2010 BASCOM HALL (0014202) HERITAGE 10 LLC Type: CBRF HCBS COMPLIANT (952) 351-4541 Class: CNA 111 OWEN RD IRREVERSIBLE DEMENTIA/ALZHEIM MONONA WI 53716 Milo Pinkerton Gender - Capacity: M/F - 41 (608) 470-8058 BOBBI STOLZ 7901 W NATIONAL AVE Low/High rate: 4,300/5,300 PUBLIC FUNDING County: DANE WEST ALLIS WI 53214 Initial License: 11/08/2012 BASCOM HALL (0014202) HERITAGE 10 LLC Type: CBRF HCBS COMPLIANT (952) 351-4541 Class: CNA 111 OWEN RD IRREVERSIBLE DEMENTIA/ALZHEIM MONONA WI 53716 Milo Pinkerton Gender - Capacity: M/F - 41 (608) 470-8058 BOBBI STOLZ 7901 W NATIONAL AVE Low/High rate: 4,300/5,300 PUBLIC FUNDING County: DANE WEST ALLIS WI 53214 Initial License: 11/08/2012 BAYSIDE Care Center / Recovery House (0013603) JOURNEY MENTAL HEALTH CENTER Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 280-2700 Class: CS 702 W MAIN ST EMOTIONALLY DISTURBED/MENTAL MADISON WI 53703 David Bertrand Gender - Capacity: M/F - 12 (608) 280-2610 HANNAH FLANAGAN 25 Kessel Court, Suite 105 Low/High rate: 9,240/13,500 PUBLIC FUNDING County: DANE Madison WI 53111 Initial License: 02/23/2011 BEEHIVE HOMES OF MOUNT HOREB (0017304) HEARTLAND ASSISTED LIVING Type: CBRF ADVANCED AGED (608) 440-0816 Class: CNA 325 N 8TH ST IRREVERSIBLE DEMENTIA/ALZHEIM MT HOREB WI 53572 URIAH MILLER Gender - Capacity: M/F - 16 (608) 437-4483 Uriah Miller 325 N 8th ST Low/High rate: 4,800/5,800 County: DANE MT HOREB WI 53572 Initial License: 09/24/2018 BEEHIVE HOMES OF OREGON (0016291) BERNARD 8:1 INC Type: CBRF ADVANCED AGED (608) 630-6793 Class: CNA 101 N BERGAMONT BLVD IRREVERSIBLE DEMENTIA/ALZHEIM OREGON WI 53575 ANDY DALSING Gender - Capacity: M/F - 18 (608) 291-0892 GINA FINE 101 N BERGAMONT BLVD Low/High rate: 4,500/6,500 County: DANE OREGON WI 53575 Initial License: 05/15/2017 BEEHIVE HOMES OF OREGON (0016291) BERNARD 8:1 INC Type: CBRF ADVANCED AGED (608) 630-6793 Class: CNA 101 N BERGAMONT BLVD IRREVERSIBLE DEMENTIA/ALZHEIM OREGON WI 53575 ANDY DALSING Gender - Capacity: M/F - 18 (608) 291-0892 GINA FINE 101 N BERGAMONT BLVD Low/High rate: 4,500/6,500 County: DANE OREGON WI 53575 Initial License: 05/15/2017

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 21 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BRIGHTER LIFE LIVING (0011577) BRIGHTER LIFE LIVING LLC Type: CBRF ADVANCED AGED (608) 712-4962 Class: CNA 901 PFLAUM RD EMOTIONALLY DISTURBED/MENTAL MADISON WI 53716 JASON STANDISH Gender - Capacity: M/F - 8 (608) 712-4962 JASON STANDISH 924 EAST MIFFLIN ST Low/High rate: 2,800/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53703 Initial License: 07/31/2006 PHYSICALLY DISABLED PUBLIC FUNDING BRIGHTSTAR SENIOR LIVING (0015502) S AND J ASSISTED CARE LLC Type: CBRF ADVANCED AGED (608) 310-3184 Class: CNA 6550 SCHROEDER RD IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53711 SUSAN RATHER Gender - Capacity: M/F - 33 (608) 620-7900 Michelle Quest 3240 UNIVERSITY AVE #3 Low/High rate: 5,610/10,600 County: DANE MADISON WI 53705 Initial License: 03/01/2015 BRIGHTSTAR SENIOR LIVING (0015502) S AND J ASSISTED CARE LLC Type: CBRF ADVANCED AGED (608) 310-3184 Class: CNA 6550 SCHROEDER RD IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53711 SUSAN RATHER Gender - Capacity: M/F - 33 (608) 620-7900 Michelle Quest 3240 UNIVERSITY AVE #3 Low/High rate: 5,610/10,600 County: DANE MADISON WI 53705 Initial License: 03/01/2015 Brightstar Senior Living of Waunakee (0017372) S AND J WAUNAKEE ASSISTED CARE LLC Type: CBRF ADVANCED AGED (608) 441-8620 Class: CNA 1001 QUINN DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM WAUNAKEE WI 53597 BONNIE CALDERA Gender - Capacity: M/F - 39 (608) 849-2322 Ryan Walsh 3240 UNIVERSITY AVE STE 3A Low/High rate: 5,725/9,400 County: DANE MADISON WI 53705 Initial License: 11/06/2018 BROOKDALE MADISON WEST AL (0015533) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 429 S YELLOWSTONE DR ADVANCED AGED MADISON WI 53719 Percell Smith Gender - Capacity: M/F - 74 (608) 277-1010 Kimberly Blum 429 S YELLOWSTONE DR Low/High rate: 4,395/7,545 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53719 Initial License: 04/01/2015 PUBLIC FUNDING BROOKDALE MADISON WEST AL/MC (110331) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 413 S YELLOWSTONE DR ADVANCED AGED MADISON WI 53719 Mark Hamley Gender - Capacity: M/F - 42 (608) 277-1010 Mark Hamley 413 S YELLOWSTONE DR Low/High rate: 4,395/7,545 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53719 Initial License: 02/04/1992 PUBLIC FUNDING BROOKDALE MIDDLETON CENTURY AVE (111027) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 6916 CENTURY AVE ADVANCED AGED MIDDLETON WI 53562 PATTY HENNEMAN Gender - Capacity: M/F - 20 (608) 827-8777 Stephanie Burris 6916 CENTURY AVE Low/High rate: 3,670/4,195 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MIDDLETON WI 53562 Initial License: 11/07/1997 PUBLIC FUNDING BROOKDALE MIDDLETON STONEFIELD (110304) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 6701 STONEFIELD RD ADVANCED AGED MIDDLETON WI 53562 KEVIN SARTO Gender - Capacity: M/F - 32 (608) 831-2707 Mitchel Reuter 6701 STONEFIELD RD Low/High rate: 4,389/5,323 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MIDDLETON WI 53562 Initial License: 04/28/1994 PUBLIC FUNDING BROOKDALE SUN PRAIRIE (110491) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 650 BROADWAY DR ADVANCED AGED SUN PRAIRIE WI 53590 Sarah Carlson Gender - Capacity: M/F - 20 (608) 825-9300 Maggie Schellhorn 650 BROADWAY DR Low/High rate: 6,745/6,745 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE SUN PRAIRIE WI 53590 Initial License: 11/25/1997 PUBLIC FUNDING CAPITAL SQUARE (0014203) HERITAGE 10 LLC Type: CBRF ADVANCED AGED (952) 351-4541 Class: CNA 111 OWEN RD PUBLIC FUNDING MONONA WI 53716 MILO Pinkerton Gender - Capacity: M/F - 34 (608) 470-8058 Bobbi Stolz 7901 W NATIONAL AVE Low/High rate: 3,600/4,800 County: DANE WEST ALLIS WI 53214 Initial License: 11/08/2012 CAPITAL SQUARE (0014203) HERITAGE 10 LLC Type: CBRF ADVANCED AGED (952) 351-4541 Class: CNA 111 OWEN RD PUBLIC FUNDING MONONA WI 53716 MILO Pinkerton Gender - Capacity: M/F - 34 (608) 470-8058 Bobbi Stolz 7901 W NATIONAL AVE Low/High rate: 3,600/4,800 County: DANE WEST ALLIS WI 53214 Initial License: 11/08/2012 CAPITAL SQUARE (0014203) HERITAGE 10 LLC Type: CBRF ADVANCED AGED (952) 351-4541 Class: CNA 111 OWEN RD PUBLIC FUNDING MONONA WI 53716 MILO Pinkerton Gender - Capacity: M/F - 34 (608) 470-8058 Bobbi Stolz 7901 W NATIONAL AVE Low/High rate: 3,600/4,800 County: DANE WEST ALLIS WI 53214 Initial License: 11/08/2012

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 22 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CAPITAL SQUARE (0014203) HERITAGE 10 LLC Type: CBRF ADVANCED AGED (952) 351-4541 Class: CNA 111 OWEN RD PUBLIC FUNDING MONONA WI 53716 MILO Pinkerton Gender - Capacity: M/F - 34 (608) 470-8058 Bobbi Stolz 7901 W NATIONAL AVE Low/High rate: 3,600/4,800 County: DANE WEST ALLIS WI 53214 Initial License: 11/08/2012 CAPITOL LAKES TERRACES (110509) CAPITOL LAKES INC Type: CBRF ADVANCED AGED (608) 283-2083 Class: CNA 345 W MAIN ST IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53703 Melissa Patterson Gender - Capacity: M/F - 48 (608) 283-2083 Keriann Anderson 345 WEST MAIN ST Low/High rate: 7,499/11,991 County: DANE MADISON WI 53703 Initial License: 04/01/1996 Association Approval: LeadingAge Wisconsin CHAMOMILE ASSISTED LIVING LTD (0008514) CHAMOMILE ASSISTED LIVING LTD Type: CBRF HCBS COMPLIANT (608) 819-0221 Class: CNA 22 MILO LANE ADVANCED AGED MADISON WI 53714 JEFF SHIELDS Gender - Capacity: M/F - 17 (608) 241-3431 JEFF SHIELDS 2724 THINNES STREET Low/High rate: 2,700/3,801 County: DANE CROSS PLAINS WI 53528 Initial License: 12/18/1998 CHAMOMILE ASSISTED LIVING LTD II (0010867) CHAMOMILE ASSISTED LIVING LTD Type: CBRF HCBS COMPLIANT (608) 798-4523 Class: CNA 842 JUPITER DR ADVANCED AGED MADISON WI 53718 JEFF SHIELDS Gender - Capacity: M/F - 24 (608) 819-0221 JEFF SHIELDS 2722 THINNES ST Low/High rate: 3,000/3,800 County: DANE CROSS PLAINS WI 53528 Initial License: 06/15/2005 COTTAGES OF MADISON APPLEWOOD (0017703) NOHC COTTAGES OF MADISON LLC Type: CBRF HCBS COMPLIANT (847) 612-0750 Class: CNA 5565 BURKE RD ADVANCED AGED MADISON WI 53718 DEAN MASCHOFF Gender - Capacity: M/F - 16 (608) 249-5776 Heidi Gehrke 5565 Burke Rd Low/High rate: 2,930/4,900 EMOTIONALLY DISTURBED/MENTAL County: DANE Madison WI 53718 Initial License: 09/03/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED COTTAGES OF MADISON ELMWOOD (0017701) NOHC COTTAGES OF MADISON LLC Type: CBRF HCBS COMPLIANT (847) 612-0750 Class: CNA 5575 BURKE RD ADVANCED AGED MADISON WI 53718 DEAN MASCHOFF Gender - Capacity: M/F - 16 (608) 249-5776 Heidi Gehrke 5575 Burke Rd. Low/High rate: 2,930/4,900 EMOTIONALLY DISTURBED/MENTAL County: DANE Madison WI 53718 Initial License: 09/03/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED COTTAGES OF MADISON OAKWOOD (0017702) NOHC COTTAGES OF MADISON LLC Type: CBRF HCBS COMPLIANT (847) 612-0750 Class: CNA 5555 BURKE RD ADVANCED AGED MADISON WI 53718 DEAN MASCHOFF Gender - Capacity: M/F - 16 (608) 249-5776 Heidi Gehrke 5575 Burke RD Low/High rate: 2,930/4,900 EMOTIONALLY DISTURBED/MENTAL County: DANE Madison WI 53718 Initial License: 09/03/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED COVENANT OAKS (0008572) OAKWOOD VILLAGE HOMES INC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM 6165 MINERAL POINT RD (608) 230-4414 Class: CNA MADISON WI 53705 KIMBERLY BLUM Gender - Capacity: M/F - 40 (608) 230-4414 KIMBERLY BLUM 6165 MINERAL POINT RD Low/High rate: 8,520/9,090 County: DANE MADISON WI 53705 Initial License: 11/01/1999 Association Approval: LeadingAge Wisconsin DEERFIELD PLACE ASSISTED LIVING (0015098) GEROU PROPERTIES LLC Type: CBRF HCBS COMPLIANT (608) 520-7539 Class: CNA 15 STATE STREET ADVANCED AGED DEERFIELD WI 53531 NIKOL GEROU Gender - Capacity: M/F - 9 (608) 764-3142 LATONYA STEFFENHAGEN 15 State Street Low/High rate: 3,500/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE Deerfield WI 53531 Initial License: 06/01/2014 PUBLIC FUNDING TERMINALLY ILL DEFOREST PLACE (0018519) DEFOREST PLACE SENIOR LIVING Type: CBRF ADVANCED AGED (312) 462-4462 Class: CNA 206 N MAIN STREET IRREVERSIBLE DEMENTIA/ALZHEIM DEFOREST WI 53532 THOMAS OSTROM Gender - Capacity: M/F - 20 (608) 846-6999 ROTH WEAVER 101 N WACKER SUITE 616 Low/High rate: 3,000/9,000 TERMINALLY ILL County: DANE CHICAGO IL 60606 Initial License: 06/01/2021

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 23 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

EVERGREEN HOME CARE LLC (0014896) HAIYAO WANG Type: CBRF HCBS COMPLIANT (608) 692-0005 Class: CNA 1003 TAMARACK WAY ADVANCED AGED VERONA WI 53593 HAIYAO WANG Gender - Capacity: M/F - 8 (608) 848-1368 HAIYAO WANG 5616 NUTONE STREET Low/High rate: 3,000/3,400 EMOTIONALLY DISTURBED/MENTAL County: DANE FITCHBURG WI 53711 Initial License: 01/09/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED EVERGREEN HOME CARE LLC (0014896) HAIYAO WANG Type: CBRF HCBS COMPLIANT (608) 692-0005 Class: CNA 1003 TAMARACK WAY ADVANCED AGED VERONA WI 53593 HAIYAO WANG Gender - Capacity: M/F - 8 (608) 848-1368 HAIYAO WANG 5616 NUTONE STREET Low/High rate: 3,000/3,400 EMOTIONALLY DISTURBED/MENTAL County: DANE FITCHBURG WI 53711 Initial License: 01/09/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED FAITH LIVING CENTER (0013790) FAITH LIVING CENTER Type: CBRF HCBS COMPLIANT (608) 712-4663 Class: CNA 131 CLARMAR DR ADVANCED AGED SUN PRAIRIE WI 53590 Barb Regan Gender - Capacity: M/F - 21 (608) 825-3178 Barb Regan 131 CLARMAR DR Low/High rate: 3,375/4,975 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE SUN PRAIRIE WI 53590 Initial License: 09/06/2011 PHYSICALLY DISABLED PUBLIC FUNDING FAITH LIVING CENTER (0013790) FAITH LIVING CENTER Type: CBRF HCBS COMPLIANT (608) 712-4663 Class: CNA 131 CLARMAR DR ADVANCED AGED SUN PRAIRIE WI 53590 Barb Regan Gender - Capacity: M/F - 21 (608) 825-3178 Barb Regan 131 CLARMAR DR Low/High rate: 3,375/4,975 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE SUN PRAIRIE WI 53590 Initial License: 09/06/2011 PHYSICALLY DISABLED PUBLIC FUNDING FOSTER COMMUNITY CORRECTIONS CENTER (110377) ATTIC CORRECTIONAL SERVICES INC Type: CBRF CORRECTIONAL CLIENTS 5706 ODANA RD (608) 223-0017 Class: AA MADISON WI 53719 TODD VIETH Gender - Capacity: M - 20 (608) 273-3055 VICKI TREBIAN PO BOX 7370 Low/High rate: 2,160/2,160 County: DANE MADISON WI 53707-7370 Initial License: 09/01/1993 FOSTER COMMUNITY CORRECTIONS CENTER (110377) ATTIC CORRECTIONAL SERVICES INC Type: CBRF CORRECTIONAL CLIENTS 5706 ODANA RD (608) 223-0017 Class: AA MADISON WI 53719 TODD VIETH Gender - Capacity: M - 20 (608) 273-3055 VICKI TREBIAN PO BOX 7370 Low/High rate: 2,160/2,160 County: DANE MADISON WI 53707-7370 Initial License: 09/01/1993 FOUR WINDS LODGE (110368) FOUR WINDS MANOR INC Type: CBRF ADVANCED AGED (608) 845-6465 Class: CNA 309 SCHWEITZER DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM VERONA WI 53593 LISA ADERS Gender - Capacity: M/F - 35 (608) 845-6154 LISA ADERS 309 SCHWEITZER DRIVE Low/High rate: 5,445/6,114 PHYSICALLY DISABLED County: DANE VERONA WI 53593 Initial License: 05/24/1993 TERMINALLY ILL GIRLIES MANOR (0010746) SENIOR CONCEPTS INC Type: CBRF HCBS COMPLIANT (608) 798-1086 Class: CNA 104 LINCOLN CRT ADVANCED AGED MOUNT HOREB WI 53572 DOUGLAS GREGORY Gender - Capacity: M/F - 20 (608) 437-2778 LANCE STEIN 2620 MILITARY RD Low/High rate: 3,900/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE CROSS PLAINS WI 53528 Initial License: 11/01/2004 PUBLIC FUNDING GIRLIES MANOR III (0008704) SENIOR CONCEPTS INC Type: CBRF HCBS COMPLIANT (608) 798-1086 Class: CNA 2620 MILITARY RD ADVANCED AGED CROSS PLAINS WI 53528 LANCE STEIN Gender - Capacity: M/F - 19 (608) 798-1086 LANCE / DOUG STEIN / GREGORY 2620 MILITARY RD Low/High rate: 4,100/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE CROSS PLAINS WI 53528 Initial License: 08/09/1999 WAIVER CERTIFIED INDEPENDENT C GOODWILL JAMESTOWN GROUP HOME (110243) GOODWILL INDUSTRIES OF SC WIS INC Type: CBRF HCBS COMPLIANT (608) 246-3140 Class: AA 5815 WILLIAMSBURG WAY EMOTIONALLY DISTURBED/MENTAL MADISON WI 53719 ELENA GOLDEN Gender - Capacity: M/F - 7 (608) 271-1036 ELENA GOLDEN 1302 MENDOTA ST Low/High rate: 3,962/3,962 PUBLIC FUNDING County: DANE MADISON WI 53714 Initial License: 12/26/1988 HAMMERSLEY HOUSE (0009770) FOUNTAINHEAD GROUP INC Type: CBRF HCBS COMPLIANT (608) 347-0366 Class: CNA 5222 HAMMERSLEY RD ADVANCED AGED MADISON WI 53711 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 274-4642 RUTH POLACEK PO BOX 46010 Low/High rate: 3,500/10,000 EMOTIONALLY DISTURBED/MENTAL County: DANE MADISON WI 53744-6010 Initial License: 02/01/2003 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 24 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HANNAHS HOUSE EAST (0016106) VANESSA GOTTSCHALK LLC Type: CBRF ADVANCED AGED (702) 510-6638 Class: CNA 4702 MILWAUKEE ST DEVELOPMENTALLY DISABLED MADISON WI 53714 VANESSA GOTTSCHALK Gender - Capacity: M/F - 8 (702) 249-4844 VANESSA GOTTSCHALK N6680 COUNTY ROAD O Low/High rate: 3,200/6,000 EMOTIONALLY DISTURBED/MENTAL County: DANE MARSHALL WI 53559 Initial License: 08/17/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED HANNAHS HOUSE WEST (0015882) HANNAHS HOUSE WEST LLC Type: CBRF HCBS COMPLIANT (608) 472-3200 Class: AA 510 N GAMMON ADVANCED AGED MADISON WI 53717 MARK SHAFFAR Gender - Capacity: M/F - 8 (608) 833-8679 MARK SHAFFAR 2327 CLARK ST Low/High rate: 3,200/5,000 EMOTIONALLY DISTURBED/MENTAL County: DANE MIDDLETON WI 53562 Initial License: 03/11/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING HERITAGE CENTER (111086) SKAALEN RETIREMENT SERVICES INC Type: CBRF ADVANCED AGED (608) 873-5651 Class: CNA 400 NORTH MORRIS ST IRREVERSIBLE DEMENTIA/ALZHEIM STOUGHTON WI 53589 Shari Kellogg Gender - Capacity: M/F - 50 (608) 873-5651 Tammy Montalto 400 NORTH MORRIS ST Low/High rate: 4,666/5,815 PUBLIC FUNDING County: DANE STOUGHTON WI 53589 Initial License: 07/31/1998 Association Approval: LeadingAge Wisconsin HERITAGE COURT MIDDLETON (0014200) HERITAGE 11 LLC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM (952) 351-4541 Class: CNA 6234 MAYWOOD AVE PUBLIC FUNDING MIDDLETON WI 53562 MILO PINKERTON Gender - Capacity: M/F - 38 (608) 831-7004 Cheri Riddle 7901 W NATIONAL AVE Low/High rate: 4,750/5,800 County: DANE WEST ALLIS WI 53214 Initial License: 01/02/2013 HERITAGE COURT MIDDLETON (0014200) HERITAGE 11 LLC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM (952) 351-4541 Class: CNA 6234 MAYWOOD AVE PUBLIC FUNDING MIDDLETON WI 53562 MILO PINKERTON Gender - Capacity: M/F - 38 (608) 831-7004 Cheri Riddle 7901 W NATIONAL AVE Low/High rate: 4,750/5,800 County: DANE WEST ALLIS WI 53214 Initial License: 01/02/2013 HERITAGE COURT MIDDLETON (0014200) HERITAGE 11 LLC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM (952) 351-4541 Class: CNA 6234 MAYWOOD AVE PUBLIC FUNDING MIDDLETON WI 53562 MILO PINKERTON Gender - Capacity: M/F - 38 (608) 831-7004 Cheri Riddle 7901 W NATIONAL AVE Low/High rate: 4,750/5,800 County: DANE WEST ALLIS WI 53214 Initial License: 01/02/2013 HERITAGE MONONA CBRF (0012891) HERITAGE 9 LLC Type: CBRF HCBS COMPLIANT (952) 351-4542 Class: CNA 111 OWEN RD IRREVERSIBLE DEMENTIA/ALZHEIM MONONA WI 53716 Milo Pinkerton Gender - Capacity: M/F - 39 (608) 470-8058 Bobbi Stolz 7901 W NATIONAL AVE Low/High rate: 4,400/7,400 PUBLIC FUNDING County: DANE WEST ALLIS WI 53214 Initial License: 11/24/2009 HERITAGE MONONA CBRF (0012891) HERITAGE 9 LLC Type: CBRF HCBS COMPLIANT (952) 351-4542 Class: CNA 111 OWEN RD IRREVERSIBLE DEMENTIA/ALZHEIM MONONA WI 53716 Milo Pinkerton Gender - Capacity: M/F - 39 (608) 470-8058 Bobbi Stolz 7901 W NATIONAL AVE Low/High rate: 4,400/7,400 PUBLIC FUNDING County: DANE WEST ALLIS WI 53214 Initial License: 11/24/2009 HERITAGE MONONA CBRF (0012891) HERITAGE 9 LLC Type: CBRF HCBS COMPLIANT (952) 351-4542 Class: CNA 111 OWEN RD IRREVERSIBLE DEMENTIA/ALZHEIM MONONA WI 53716 Milo Pinkerton Gender - Capacity: M/F - 39 (608) 470-8058 Bobbi Stolz 7901 W NATIONAL AVE Low/High rate: 4,400/7,400 PUBLIC FUNDING County: DANE WEST ALLIS WI 53214 Initial License: 11/24/2009 HERITAGE MONONA CBRF (0012891) HERITAGE 9 LLC Type: CBRF HCBS COMPLIANT (952) 351-4542 Class: CNA 111 OWEN RD IRREVERSIBLE DEMENTIA/ALZHEIM MONONA WI 53716 Milo Pinkerton Gender - Capacity: M/F - 39 (608) 470-8058 Bobbi Stolz 7901 W NATIONAL AVE Low/High rate: 4,400/7,400 PUBLIC FUNDING County: DANE WEST ALLIS WI 53214 Initial License: 11/24/2009 HOME AGAIN ASSISTED LIVING INC (0015855) HOME AGAIN ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 423-9333 Class: CNA 308 ENGLAND STREET ADVANCED AGED CAMBRIDGE WI 53523 MELISSA OCONNOR Gender - Capacity: M/F - 47 (608) 423-9333 MELISSA OCONNOR 3120 Edmonton Dr. STE 3 Low/High rate: 2,500/9,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE Sun Prairie WI 53590 Initial License: 10/15/2015 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 25 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HOMESTEAD LIVING INC (0012266) HOMESTEAD LIVING INC Type: CBRF HCBS COMPLIANT (612) 695-4906 Class: CNA 1040 QUINN DR IRREVERSIBLE DEMENTIA/ALZHEIM WAUNAKEE WI 53597 CHAD ARMBRUSTER Gender - Capacity: M/F - 16 (608) 850-4610 Troy Armbruster 1040 QUINN DRIVE Low/High rate: 4,490/6,100 County: DANE WAUNAKEE WI 53597 Initial License: 12/30/2008 HOMESTEAD LIVING INC (0012266) HOMESTEAD LIVING INC Type: CBRF HCBS COMPLIANT (612) 695-4906 Class: CNA 1040 QUINN DR IRREVERSIBLE DEMENTIA/ALZHEIM WAUNAKEE WI 53597 CHAD ARMBRUSTER Gender - Capacity: M/F - 16 (608) 850-4610 Troy Armbruster 1040 QUINN DRIVE Low/High rate: 4,490/6,100 County: DANE WAUNAKEE WI 53597 Initial License: 12/30/2008 HOMETOWN ASSISTED LIVING INC (0013853) HOMETOWN ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 574-6337 Class: CNA 2 HERITAGE LANE ADVANCED AGED BELLEVILLE WI 53508 LISA KLEIN Gender - Capacity: M/F - 8 (608) 424-0174 LISA KLEIN 2 HERITAGE LANE Low/High rate: 3,500/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE BELLEVILLE WI 53508 Initial License: 09/23/2011 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY HYLAND CROSSINGS (0017238) CHIARA COMMUNITIES INC Type: CBRF ADVANCED AGED (262) 798-1224 Class: CNA 1249 SCHOOL ST IRREVERSIBLE DEMENTIA/ALZHEIM SUN PRAIRIE WI 53590 GLEN CHOBAN Gender - Capacity: M/F - 28 (608) 318-5810 RENEE SIDEBOTTOM 20875 CROSSROADS CIR STE 400 Low/High rate: 5,980/7,375 PHYSICALLY DISABLED County: DANE WAUKESHA WI 53186 Initial License: 11/01/2018 PUBLIC FUNDING TERMINALLY ILL INGLEHAVEN (0015157) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF ADVANCED AGED (608) 437-5511 Class: CNA 512 ALAN DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM MOUNT HOREB WI 53572 Danielle Sigler Gender - Capacity: M/F - 16 (608) 437-9648 Cindy Brown 407 N 8TH STREET Low/High rate: 4,550/5,150 PHYSICALLY DISABLED County: DANE MOUNT HOREB WI 53572 Initial License: 08/01/2014 J & B ASSISTED LIVING INC (0016597) J & B ASSISTED LIVING INC Type: CBRF ADVANCED AGED 1013 GATEWAY PASS (608) 213-5348 Class: CNA VERONA WI 53593 JAMPA DOLMA Gender - Capacity: M/F - 8 (608) 848-9619 JAMPA DOLMA 1253 TWINLEAF LANE Low/High rate: 3,050/4,000 County: DANE MADISON WI 53719 Initial License: 06/05/2017 KETTLE PARK SENIOR LIVING INC (0017669) KETTLE PARK SENIOR LIVING INC Type: CBRF ADVANCED AGED (608) 664-3500 Class: CNA 2600 JACKSON ST IRREVERSIBLE DEMENTIA/ALZHEIM STOUGHTON WI 53589 MICHELLE POWLESS Gender - Capacity: M/F - 21 (608) 579-5601 MICHELLE POWLESS 2600 JACKSON ST Low/High rate: 6,700/8,400 County: DANE STOUGHTON WI 53589 Initial License: 09/16/2019 Association Approval: WiCAL KEYES HOUSE (0015686) FOUNTAINHEAD LIVING INC Type: CBRF ADVANCED AGED (608) 347-0366 Class: CNA 4141 SAVANNAH DRIVE EMOTIONALLY DISTURBED/MENTAL DEFOREST WI 53532 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 347-0366 RUTH POLACEK PO BOX 46010 Low/High rate: 5,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53744 Initial License: 08/10/2015 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY KINDREDHEARTS OF COTTAGE GROVE (0011776) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 505 W LAWN DR ADVANCED AGED COTTAGE GROVE WI 53527 Michelle Lewis Gender - Capacity: M/F - 20 (608) 839-5343 Michelle Lewis 505 WEST LAWN DR Low/High rate: 3,945/3,945 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE COTTAGE GROVE WI 53527 Initial License: 01/31/2007 PUBLIC FUNDING KINDREDHEARTS OF COTTAGE GROVE (0011775) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 325 W COTTAGE GROVE RD ADVANCED AGED COTTAGE GROVE WI 53527 MICHELLE LEWIS Gender - Capacity: M/F - 15 (608) 839-1555 MICHELLE LEWIS 325 W COTTAGE GROVE RD Low/High rate: 3,828/5,759 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE COTTAGE GROVE WI 53527 Initial License: 01/31/2007 PUBLIC FUNDING WAIVER CERTIFIED INDEPENDENT C

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 26 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LEGACY OF DEFOREST (THE) (0017768) PARK VISTA SENIOR HOUSING MANAGEMENT L Type: CBRF HCBS COMPLIANT (563) 503-6001 Class: CNA 6639 PEDERSON CROSSING BLVD ADVANCED AGED DEFOREST WI 53532 JULIE LONERGAN Gender - Capacity: M/F - 25 (608) 807-2888 KELLEY ROBINSON 132 6TH AVE S Low/High rate: 2,450/7,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE CLINTON IA 52732 Initial License: 10/19/2019 TERMINALLY ILL MADISON POINTE SENIOR LIVING (0015621) MADISON SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (608) 244-8863 Class: CNA 705 ZIEGLER RD ADVANCED AGED MADISON WI 53714 Lee Johnson Gender - Capacity: M/F - 47 (608) 244-8863 MICHAEL STEMM 1675 E Riverside Dr, STE 150 Low/High rate: 3,650/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE Eagle ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL MAGNOLIA GARDENS (0016611) SKAALEN RETIREMENT SERVICES INC Type: CBRF ADVANCED AGED (608) 873-5651 Class: CNA 400 N MORRIS STREET IRREVERSIBLE DEMENTIA/ALZHEIM STOUGHTON WI 53589 SHARI KELLOGG Gender - Capacity: M/F - 18 (608) 873-5651 Tammy Montalto 400 N MORRIS STREET Low/High rate: 5,250/5,975 County: DANE STOUGHTON WI 53589 Initial License: 05/19/2017 Association Approval: LeadingAge Wisconsin MAHER HOME (THE) (0013573) BRIGHTER LIFE LIVING LLC Type: CBRF HCBS COMPLIANT (608) 712-4962 Class: CS 5225 MAHER AVE ADVANCED AGED MADISON WI 53716 JASON STANDISH Gender - Capacity: M/F - 8 (608) 712-4962 JASON STANDISH 924 E MIFFLIN ST Low/High rate: 2,800/5,000 EMOTIONALLY DISTURBED/MENTAL County: DANE MADISON WI 53703 Initial License: 11/28/2011 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING MARIANNES ELDER HOUSE INC (110170) MARIANNES ELDER HOUSE INC Type: CBRF HCBS COMPLIANT (608) 838-9524 Class: CNA 6229 RENEE CT ADVANCED AGED MCFARLAND WI 53558 MARI LYNN STASSI Gender - Capacity: M/F - 10 (608) 838-9524 MARI LYNN STASSI 6229 RENEE CT Low/High rate: 4,500/5,500 DEVELOPMENTALLY DISABLED County: DANE MCFARLAND WI 53558 Initial License: 07/31/1994 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING MILESTONE SENIOR LIVING MARKET ST CBRF (0017058) ABILIT HOLDINGS CROSS PLAINS LLC Type: CBRF ADVANCED AGED (858) 500-6793 Class: CNA 1870 MARKET ST IRREVERSIBLE DEMENTIA/ALZHEIM CROSS PLAINS WI 53528 SARAH SEARLES Gender - Capacity: M/F - 22 (608) 413-0453 Angela Starcer 316 Heritage Square Dr. Low/High rate: 4,500/7,500 County: DANE Deerfield WI 55409 Initial License: 05/18/2018 MILESTONE SENIOR LIVING STOUGHTON CBRF (0017056 ABILIT HOLDINGS STOUGHTON LLC Type: CBRF ADVANCED AGED (858) 500-6793 Class: CNA 2220 LINCOLN AVE IRREVERSIBLE DEMENTIA/ALZHEIM STOUGHTON WI 53589 SARAH SEARLES Gender - Capacity: M/F - 22 (608) 205-6800 Dana Anderstrom 316 Heritage Square Dr. Low/High rate: 4,500/7,500 County: DANE Deerfield WI 55409 Initial License: 05/18/2018 NEW PERSPECTIVE SUN PRAIRIE (0015199) SUN PRAIRIE OPS LLC Type: CBRF HCBS COMPLIANT (952) 241-8204 Class: CNA 222 S BRISTOL STREET ADVANCED AGED SUN PRAIRIE WI 53590 RYAN NOVACZYK Gender - Capacity: M/F - 50 (608) 825-1600 Colin O'Brien 5900 Clearwater Dr. SUITE 500 Low/High rate: 4,348/9,788 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE Minnetonka MN 55343 Initial License: 07/25/2014 NEW PERSPECTIVE SUN PRAIRIE (0015199) SUN PRAIRIE OPS LLC Type: CBRF HCBS COMPLIANT (952) 241-8204 Class: CNA 222 S BRISTOL STREET ADVANCED AGED SUN PRAIRIE WI 53590 RYAN NOVACZYK Gender - Capacity: M/F - 50 (608) 825-1600 Colin O'Brien 5900 Clearwater Dr. SUITE 500 Low/High rate: 4,348/9,788 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE Minnetonka MN 55343 Initial License: 07/25/2014 NORTHPORT GROUP HOME (110130) GOODWILL INDUSTRIES OF MADISON Type: CBRF HCBS COMPLIANT (608) 246-3140 Class: AA 1602 NORTHPORT DR EMOTIONALLY DISTURBED/MENTAL MADISON WI 53704 ELENA GOLDEN Gender - Capacity: M/F - 8 (608) 663-4552 ELENA GOLDEN 1302 MENDOTA ST Low/High rate: 3,043/3,043 PUBLIC FUNDING County: DANE MADISON WI 53714 Initial License: 12/31/1981

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 27 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

OAK PARK PLACE AUTUMN LANE (0011449) OAK PARK PLACE OF MADISON LLC Type: CBRF ADVANCED AGED (608) 663-8600 Class: CNA 702 JUPITER DR IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53718 TONI CARRUTHERS Gender - Capacity: M/F - 36 (608) 663-8600 TONI CARRUTHERS 719 JUPITER DR Low/High rate: 5,408/6,891 TERMINALLY ILL County: DANE MADISON WI 53718 Initial License: 06/01/2006 TRAUMATIC BRAIN INJURY OAK PARK PLACE AUTUMN LANE (0011449) OAK PARK PLACE OF MADISON LLC Type: CBRF ADVANCED AGED (608) 663-8600 Class: CNA 702 JUPITER DR IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53718 TONI CARRUTHERS Gender - Capacity: M/F - 36 (608) 663-8600 TONI CARRUTHERS 719 JUPITER DR Low/High rate: 5,408/6,891 TERMINALLY ILL County: DANE MADISON WI 53718 Initial License: 06/01/2006 TRAUMATIC BRAIN INJURY OAK PARK PLACE AUTUMN LANE II (0014642) OAK PARK II MADISON LLC Type: CBRF ADVANCED AGED (608) 729-2900 Class: CNA 719 JUPITER DR IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53718 CHAD BASCHE Gender - Capacity: M/F - 67 (608) 729-2900 Kara Lundlum 719 JUPITER DR Low/High rate: 5,921/8,344 County: DANE MADISON WI 53718 Initial License: 05/21/2013 OAK PARK PLACE AUTUMN LANE II (0014642) OAK PARK II MADISON LLC Type: CBRF ADVANCED AGED (608) 729-2900 Class: CNA 719 JUPITER DR IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53718 CHAD BASCHE Gender - Capacity: M/F - 67 (608) 729-2900 Kara Lundlum 719 JUPITER DR Low/High rate: 5,921/8,344 County: DANE MADISON WI 53718 Initial License: 05/21/2013 OAK PARK PLACE OF NAKOMA (0017289) OAK PARK PLACE OF NAKOMA LLC Type: CBRF ADVANCED AGED (608) 279-0378 Class: CNA 4327 NAKOMA RD IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53711 CELIA HOLTON Gender - Capacity: M/F - 45 (608) 279-0378 CELIA HOLTON 719 JUPITER DR Low/High rate: 2,100/4,300 TERMINALLY ILL County: DANE MADISON WI 53718 Initial License: 01/04/2019 OAK RIDGE LIVING MADISON WEST (0016301) OAK RIDGE LIVING LLC Type: CBRF ADVANCED AGED (608) 444-8718 Class: CNA 8410 BLACKWOLF DR IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53717 COURTNEY ODOM Gender - Capacity: M/F - 5 (608) 833-4813 COURTNEY ODOM 605 WOOD VIOLET LN Low/High rate: 3,800/6,000 PHYSICALLY DISABLED County: DANE SUN PRAIRIE WI 53590 Initial License: 09/29/2016 OAK RIDGE LIVING SUN PRAIRIE (0016303) OAK RIDGE LIVING LLC Type: CBRF ADVANCED AGED (608) 444-8718 Class: CNA 605 WOOD VIOLET LN IRREVERSIBLE DEMENTIA/ALZHEIM SUN PRAIRIE WI 53590 COURTNEY ODOM Gender - Capacity: M/F - 8 (608) 837-6018 COURTNEY ODOM 605 WOOD VIOLET LN Low/High rate: 3,800/6,000 PHYSICALLY DISABLED County: DANE SUN PRAIRIE WI 53590 Initial License: 09/29/2016 OAK RIDGE LIVING WINDSOR (0016302) OAK RIDGE LIVING LLC Type: CBRF ADVANCED AGED (608) 444-8718 Class: CNA 6797 VALIANT DR IRREVERSIBLE DEMENTIA/ALZHEIM WINDSOR WI 53598 COURTNEY ODOM Gender - Capacity: M/F - 6 (608) 846-9316 COURTNEY ODOM 605 WOOD VIOLET LN Low/High rate: 3,800/6,000 PHYSICALLY DISABLED County: DANE SUN PRAIRIE WI 53590 Initial License: 09/29/2016 PUBLIC FUNDING OAKWOOD KNOLL (0009395) OAKWOOD VILLAGE E LUTH HOMES INC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM (608) 230-4623 Class: CNA 5565 TANCHO DR PUBLIC FUNDING MADISON WI 53718 LYNNETTE WHITE Gender - Capacity: M/F - 20 (608) 230-4623 Kimberly Gochanour 5565 TANCHO DR Low/High rate: 7,020/8,100 County: DANE MADISON WI 53718 Initial License: 09/25/2001 Association Approval: LeadingAge Wisconsin OAKWOOD MEADOWS (0011119) OAKWOOD VILLAGE EAST Type: CBRF HCBS COMPLIANT (608) 230-4623 Class: CNA 5565 TANCHO DR IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53718 LYNNETTE WHITE Gender - Capacity: M/F - 20 (608) 230-4623 Kimberly Gochanour 5565 TANCHO DR Low/High rate: 8,730/8,910 PUBLIC FUNDING County: DANE MADISON WI 53718 Initial License: 04/01/2006 Association Approval: LeadingAge Wisconsin OAKWOOD VILLAGE TABOR OAKS (110198) OAKWOOD VILLAGE UNIVERSITY WOODS APAR Type: CBRF ADVANCED AGED 6175 MINERAL POINT RD (608) 230-4257 Class: CNA MADISON WI 53705 KIMBERLY BLUM Gender - Capacity: M/F - 60 (608) 230-4699 KIMBERLY BLUM 6175 MINERAL POINT RD Low/High rate: 2,546/6,360 County: DANE MADISON WI 53705 Initial License: 07/01/1992 Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 28 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

OFFSHORE GROUP HOME (110075) GOODWILL INDUSTRIES SOUTH CENTRAL WISC Type: CBRF HCBS COMPLIANT (608) 246-3140 Class: AA 6418 OFFSHORE DR EMOTIONALLY DISTURBED/MENTAL MADISON WI 53705 ELENA GOLDEN Gender - Capacity: M/F - 8 (608) 238-9064 ELENA GOLDEN 1302 MENDOTA ST Low/High rate: 3,989/3,989 PUBLIC FUNDING County: DANE MADISON WI 53714 Initial License: 06/01/1983 OUR HOUSE CAMBRIDGE ASSISTED CARE (0013377) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 201 W MADISON ST ADVANCED AGED CAMBRIDGE WI 53523 LORI NARDIN Gender - Capacity: M/F - 15 (608) 423-9961 Ryan Wagner 4350 156th ST Low/High rate: 3,785/3,885 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING PORCHLIGHT (110310) PORCHLIGHT INC Type: CBRF HCBS COMPLIANT (608) 257-2534 Class: AA 902 NORTHPORT DR EMOTIONALLY DISTURBED/MENTAL MADISON WI 53704 KARLA THENNES Gender - Capacity: M - 8 (608) 242-6288 Glenn Ruiz 306 N BROOKS ST Low/High rate: 1/500 PUBLIC FUNDING County: DANE MADISON WI 53715 Initial License: 06/10/1991 PRAIRIE GARDENS (0010589) PGRF LLC Type: CBRF HCBS COMPLIANT (608) 837-0401 Class: CNA 900 OKEEFFE AVE ADVANCED AGED SUN PRAIRIE WI 53590 JERRY & SUZANNE HARBORT Gender - Capacity: M/F - 53 (608) 825-4884 JERRY & SUZANNE HARBORT 900 O'KEEFFE AVE Low/High rate: 4,000/4,500 PHYSICALLY DISABLED County: DANE SUN PRAIRIE WI 53590 Initial License: 05/12/2004 PUBLIC FUNDING RATHEY HOUSE (0016848) FOUNTAINHEAD LIVING INC Type: CBRF ADVANCED AGED (608) 347-0366 Class: CNA 4139 SAVANNAH DR EMOTIONALLY DISTURBED/MENTAL DEFOREST WI 53532 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 244-6768 RUTH POLACEK PO BOX 46010 Low/High rate: 5,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53744 Initial License: 10/24/2017 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY RAYMOND HOUSE (THE) (0012297) FOUNTAINHEAD GROUP INC Type: CBRF HCBS COMPLIANT (608) 347-0366 Class: CNA 825 SOUTHBOUND DR ADVANCED AGED DEFOREST WI 53532 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 842-0406 RUTH POLACEK PO BOX 46010 Low/High rate: 4,300/7,500 EMOTIONALLY DISTURBED/MENTAL County: DANE MADISON WI 53744 Initial License: 06/04/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED RISE AT OAKWOOD VILLAGE PRAIRIE RIDGE (THE) (0017 OAKWOOD VILLAGE PRAIRIE RIDGE HOMES INC Type: CBRF ADVANCED AGED 5565 TANCHO DR (608) 230-4000 Class: CNA MADISON WI 53718 LYNNETTE WHITE Gender - Capacity: M/F - 40 (608) 230-4000 Kimberly Gochanour 5565 TANCHO DR Low/High rate: 8,700/9,900 County: DANE MADISON WI 53718 Initial License: 11/07/2019 Association Approval: LeadingAge Wisconsin ROSMAN HOUSE (0016850) FOUNTAINHEAD LIVING INC Type: CBRF ADVANCED AGED (608) 347-0366 Class: CNA 4145 SAVANNAH DR EMOTIONALLY DISTURBED/MENTAL DEFOREST WI 53532 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 416-4273 RUTH POLACEK PO BOX 46010 Low/High rate: 5,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53744 Initial License: 01/15/2018 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY SAGE MEADOW MIDDLETON AL (0017587) A6 MIDDLETON AL LLC Type: CBRF HCBS COMPLIANT (312) 462-4462 Class: CNA 5340 CENTURY AVE ADVANCED AGED MIDDLETON WI 53562 THOMAS OSTROM Gender - Capacity: M/F - 44 (608) 843-4386 ROTH WEAVER 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/9,000 EMOTIONALLY DISTURBED/MENTAL County: DANE CHICAGO IL 60606 Initial License: 05/30/2019 IRREVERSIBLE DEMENTIA/ALZHEIM TERMINALLY ILL SAGE MEADOW MIDDLETON MC (0017591) A6 MIDDLETON MC LLC Type: CBRF HCBS COMPLIANT (312) 462-4462 Class: CNA 5330 CENTURY AVE ADVANCED AGED MIDDLETON WI 53562 THOMAS OSTROM Gender - Capacity: M/F - 52 (608) 843-4386 ROTH WEAVER 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE CHICAGO IL 60606 Initial License: 05/30/2019 TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 29 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SCHWERT AODA TREATMENT CENTER (110289) ATTIC CORRECTIONAL SERVICES INC Type: CBRF CORRECTIONAL CLIENTS 3501 KIPLING DR (608) 223-0017 Class: ANA MADISON WI 53704 TODD VIETH Gender - Capacity: M - 15 (608) 249-6226 VICKI TREBIAN 4117 Dwight Drive Low/High rate: 37,194/38,994 County: DANE MADISON WI 53704 Initial License: 09/18/1990 SCHWERT AODA TREATMENT CENTER (110289) ATTIC CORRECTIONAL SERVICES INC Type: CBRF CORRECTIONAL CLIENTS 3501 KIPLING DR (608) 223-0017 Class: ANA MADISON WI 53704 TODD VIETH Gender - Capacity: M - 15 (608) 249-6226 VICKI TREBIAN 4117 Dwight Drive Low/High rate: 37,194/38,994 County: DANE MADISON WI 53704 Initial License: 09/18/1990 SEBRING ASSISTED CARE RESIDENCE (0015333) SNH SE TENANT TRS INC Type: CBRF ADVANCED AGED (617) 796-8350 Class: CNA 7710 SOUTH BROOKLINE DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53719 LISA NEWCOMB Gender - Capacity: M/F - 81 (608) 662-7622 Melissa Jacobson 400 CENTRE ST Low/High rate: 5,146/7,471 County: DANE NEWTON MA 02458 Initial License: 12/01/2014 SEBRING ASSISTED CARE RESIDENCE (0015333) SNH SE TENANT TRS INC Type: CBRF ADVANCED AGED (617) 796-8350 Class: CNA 7710 SOUTH BROOKLINE DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53719 LISA NEWCOMB Gender - Capacity: M/F - 81 (608) 662-7622 Melissa Jacobson 400 CENTRE ST Low/High rate: 5,146/7,471 County: DANE NEWTON MA 02458 Initial License: 12/01/2014 SIENNA CREST MARSHALL (111052) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 604 LEWELLEN STREET ADVANCED AGED MARSHALL WI 53559 SUSAN WHITE Gender - Capacity: M/F - 20 (608) 655-3507 SUSAN WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 4,000/6,000 EMOTIONALLY DISTURBED/MENTAL County: DANE OREGON WI 53575 Initial License: 01/31/1998 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING SIENNA CREST OREGON (111073) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 981 PARK STREET ADVANCED AGED OREGON WI 53575 SUE WHITE Gender - Capacity: M/F - 24 (608) 835-7781 SUE WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 3,780/5,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE OREGON WI 53575 Initial License: 09/25/1998 PUBLIC FUNDING SIENNA CREST WAUNAKEE (0014866) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 200 CROSS ST ADVANCED AGED WAUNAKEE WI 53597 SUE WHITE Gender - Capacity: M/F - 22 (608) 849-7395 SUE WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 4,090/5,590 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE OREGON WI 53575 Initial License: 12/02/2013 PUBLIC FUNDING SIENNA MEADOWS DEFOREST (0017763) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 504 BASSETT ST ADVANCED AGED DEFOREST WI 53532 SUE WHITE Gender - Capacity: M/F - 15 (608) 846-8610 SUE WHITE 845 MARKET ST Low/High rate: 4,300/6,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE DEFOREST WI 53575 Initial License: 08/01/2019 PUBLIC FUNDING SIENNA MEADOWS OF OREGON (0009869) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 989 PARK ST ADVANCED AGED OREGON WI 53575 SUSAN WHITE Gender - Capacity: M/F - 20 (608) 835-0000 SUSAN WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 4,700/6,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE OREGON WI 53575 Initial License: 12/09/2002 PUBLIC FUNDING TRAUMATIC BRAIN INJURY SO CLOSE TO HOME (0015187) Gerou Properties II LLC Type: CBRF HCBS COMPLIANT (608) 520-7539 Class: CNA 202 LAKEWOOD TERRACE ADVANCED AGED MARSHALL WI 53559 NIKOL GEROU Gender - Capacity: M/F - 9 (608) 655-8008 LATONYA STEFFENHAGEN W290 N4595 TOLBERT LANE Low/High rate: 3,500/4,200 EMOTIONALLY DISTURBED/MENTAL County: DANE HARTLAND WI 53029 Initial License: 03/03/2015 IRREVERSIBLE DEMENTIA/ALZHEIM TERMINALLY ILL SOSA HOUSE (0016851) FOUNTAINHEAD LIVING INC Type: CBRF ADVANCED AGED (608) 347-0366 Class: CNA 4145 SAVANNAH DR EMOTIONALLY DISTURBED/MENTAL DEFOREST WI 53532 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 416-8718 RUTH POLACEK PO BOX 46010 Low/High rate: 5,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53744 Initial License: 01/15/2018 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 30 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

STOUGHTON MEADOWS ASSISTED LIVING (0015620) STOUGHTON SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (608) 877-1227 Class: CNA 2321 JACKSON ST ADVANCED AGED STOUGHTON WI 53589 Lee Johnson Gender - Capacity: M/F - 45 (262) 758-3077 Tiffany Morth 1675 E Riverside Drive STE 150 Low/High rate: 4,000/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE Eagle ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL SYLVAN CROSSINGS AT CHAPEL VALLEY (0008561) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 5765 CHAPEL VALLEY RD ADVANCED AGED FITCHBURG WI 53711 DANIEL FLEMING Gender - Capacity: M/F - 21 (608) 277-1111 Lindsay Denver 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 4,235/7,735 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53711 Initial License: 03/01/1999 SYLVAN CROSSINGS AT CHAPEL VALLEY (0008561) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 5765 CHAPEL VALLEY RD ADVANCED AGED FITCHBURG WI 53711 DANIEL FLEMING Gender - Capacity: M/F - 21 (608) 277-1111 Lindsay Denver 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 4,235/7,735 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53711 Initial License: 03/01/1999 SYLVAN CROSSINGS AT CHAPEL VALLEY (0008561) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 5765 CHAPEL VALLEY RD ADVANCED AGED FITCHBURG WI 53711 DANIEL FLEMING Gender - Capacity: M/F - 21 (608) 277-1111 Lindsay Denver 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 4,235/7,735 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53711 Initial License: 03/01/1999 SYLVAN CROSSINGS OF FITCHBURG (110524) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 5784 CHAPEL VALLEY RD ADVANCED AGED FITCHBURG WI 53711 DANIEL FLEMING Gender - Capacity: M/F - 19 (608) 274-1113 Alexandria Carr 2960 TRIVERTON PIKE Low/High rate: 5,360/6,230 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53711 Initial License: 09/01/1996 PUBLIC FUNDING SYLVAN CROSSINGS OF FITCHBURG (110524) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 5784 CHAPEL VALLEY RD ADVANCED AGED FITCHBURG WI 53711 DANIEL FLEMING Gender - Capacity: M/F - 19 (608) 274-1113 Alexandria Carr 2960 TRIVERTON PIKE Low/High rate: 5,360/6,230 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53711 Initial License: 09/01/1996 PUBLIC FUNDING TELLURIAN ACEWOOD HOUSE (110326) TELLURIAN INC Type: CBRF HCBS COMPLIANT (608) 712-3564 Class: AA 221 ACEWOOD BLVD EMOTIONALLY DISTURBED/MENTAL MADISON WI 53714 Erin Kollenbroich Gender - Capacity: M/F - 7 (608) 244-1359 Erin Kollenbroich 5900 Monona Dr STE 300 Low/High rate: 3,597/3,597 PUBLIC FUNDING County: DANE MADISON WI 53716 Initial License: 12/13/1991 TELLURIAN ADULT RESIDENTIAL SERVICES (110522) TELLURIAN INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 222-7311 Class: CNA 300 FEMRITE DR EMOTIONALLY DISTURBED/MENTAL MONONA WI 53716 ANN GILE Gender - Capacity: M/F - 38 (608) 222-7311 ANN GILE 5900 Monona Dr. #300 Low/High rate: 25/5,670 PUBLIC FUNDING County: DANE MONONA WI 53716 Initial License: 08/05/1996 TELLURIAN CRAWFORD HOUSE (110366) TELLURIAN INC Type: CBRF EMOTIONALLY DISTURBED/MENTAL (608) 712-3564 Class: AS 4326 CRAWFORD DR PUBLIC FUNDING MADISON WI 53711 Vanessa Hodgson Gender - Capacity: M/F - 7 (608) 277-8768 Vanessa Hodgson 4326 CRAWFORD DRIVE Low/High rate: 4,208/4,208 County: DANE MADISON WI 53711 Initial License: 04/26/1993 TELLURIAN TRANSITIONAL HOUSING (0009432) TELLURIAN INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 662-2120 Class: CNA 300 FEMRITE DR EMOTIONALLY DISTURBED/MENTAL MADISON WI 53716 Quality Assurance Manager Gender - Capacity: M/F - 20 (608) 663-2121 5900 Monona Drive Suite 300 Low/High rate: 0/2,973 PHYSICALLY DISABLED County: DANE Monona WI 53716 Initial License: 03/15/2002 PUBLIC FUNDING TENDER REFLECTIONS OF DEFOREST (0016737) MIDWEST ASSISTED LIVING PARTNERS III LLC Type: CBRF HCBS COMPLIANT (715) 726-9330 Class: CNA 4897 INNOVATION DR ADVANCED AGED DEFOREST WI 53532 CURT CROTTY Gender - Capacity: M/F - 55 (608) 842-2693 Chirstian Ellestad 13663 245th Ave Low/High rate: 3,100/7,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE Bloomer WI 54729 Initial License: 08/17/2017 TENNYSON SENIOR LIVING COMMUNITY CBRF (0017415) INDEPENDENT LIVING INC Type: CBRF ADVANCED AGED (920) 246-5427 Class: CNA 1936 TENNYSON LANE IRREVERSIBLE DEMENTIA/ALZHEIM MADISON WI 53704 LESLIE HYLAND Gender - Capacity: M/F - 36 (608) 268-5499 Kelly Robinson 5555 W GRANDE MARKET DR STE A Low/High rate: 4,100/6,000 PHYSICALLY DISABLED County: DANE APPLETON WI 54913 Initial License: 12/01/2018 *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 31 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

TIMBERWOOD LODGE LLC (0017222) TIMBERWOOD LODGE LLC Type: CBRF HCBS COMPLIANT (608) 225-1039 Class: CNA 7102 TIMBERWOOD DR ADVANCED AGED MADISON WI 53719 JAMES BACHMANN Gender - Capacity: M/F - 8 (608) 497-3010 James A. Bachmann 501 LINDEN ST Low/High rate: 3,500/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE VERONA WI 53593 Initial License: 08/23/2018 PHYSICALLY DISABLED TERMINALLY ILL TRADITIONS OF MADISON (0018175) TRADITIONS OF MADISON LLC Type: CBRF HCBS COMPLIANT (608) 286-1270 Class: CNA 734 MESTA LANE ADVANCED AGED MADISON WI 53704 ROGER CARLSEN Gender - Capacity: M/F - 17 (608) 286-1270 JOE MONROE PO Box 143 Low/High rate: 3,900/4,198 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE KASSON MN 55944 Initial License: 09/03/2020 PHYSICALLY DISABLED WAUNAKEE MANOR CBRF RETIREMENT WING (0017010) WAUNAKEE OPERATIONS LLC Type: CBRF ADVANCED AGED (310) 337-1929 Class: CNA 801 S KLEIN DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM WAUNAKEE WI 53597 Susan Ohm Gender - Capacity: M/F - 15 (608) 849-5016 Dominique Kittel 801 S. Klien Dr Low/High rate: 3,800/5,000 PHYSICALLY DISABLED County: DANE Waunakee WI 53597 Initial License: 03/01/2018 TERMINALLY ILL WEATHERLY HOUSE (0016849) FOUNTAINHEAD LIVING INC Type: CBRF ADVANCED AGED (608) 347-0366 Class: CNA 4139 SAVANNAH DR EMOTIONALLY DISTURBED/MENTAL DEFOREST WI 53532 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 244-4182 RUTH POLACEK PO BOX 46010 Low/High rate: 4,200/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53744 Initial License: 10/24/2017 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY WHITNEY LODGE II (THE) (0011717) EUMIJAH MILLER-WILLIAMS Type: CBRF EMOTIONALLY DISTURBED/MENTAL 209 N WHITNEY WAY (608) 239-5345 Class: CS MADISON WI 53705 EUMIJAH MILLER-WILLIAMS Gender - Capacity: M/F - 8 (608) 819-0475 EUMIJAH MILLER-WILLIAMS 7659 FARMINGTON WAY Low/High rate: 4,500/20,000 County: DANE MADISON WI 53717 Initial License: 04/06/2007 WILLOW POINTE MEMORY CARE (0014805) SNH SE TENANT TRS INC Type: CBRF HCBS COMPLIANT (617) 796-8350 Class: CNA 143 PRAIRIE OAKS DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM VERONA WI 53593 LISA NEWCOMB Gender - Capacity: M/F - 20 (608) 848-5601 Melissa Jacobson 400 CENTER STREET Low/High rate: 4,661/5,124 County: DANE NEWTON MA 02458 Initial License: 11/01/2013 WOMEN IN TRANSITION (110025) WOMEN IN TRANSITION INC Type: CBRF HCBS COMPLIANT (608) 244-2046 Class: AA 2842 MOLAND ST EMOTIONALLY DISTURBED/MENTAL MADISON WI 53704 GABRIELLE Richardson Gender - Capacity: F - 12 (608) 244-2046 GABRIELLE Richardson 2842 MOLAND ST Low/High rate: 3,665/3,665 County: DANE MADISON WI 53704 Initial License: 08/31/1980 YOUNG HOUSE (0015688) FOUNTAINHEAD LIVING INC Type: CBRF ADVANCED AGED (608) 347-0366 Class: CNA 4141 SAVANNAH DRIVE EMOTIONALLY DISTURBED/MENTAL DEFOREST WI 53532 RUTH POLACEK Gender - Capacity: M/F - 8 (608) 347-0366 RUTH POLACEK PO BOX 46010 Low/High rate: 5,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DANE MADISON WI 53744 Initial License: 08/10/2015 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY ANCHOR COMMUNITIES LLC (0015950) ANCHOR COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (920) 470-4008 Class: CNA 209 FOREST ST ADVANCED AGED FOX LAKE WI 53933 Stephanie McNicol Gender - Capacity: M/F - 14 (920) 520-0122 Stephanie McNicol 209 FOREST ST Low/High rate: 3,850/4,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE FOX LAKE WI 53933 Initial License: 01/21/2016 PUBLIC FUNDING TERMINALLY ILL ANCHOR COMMUNITIES LLC (0015950) ANCHOR COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (920) 470-4008 Class: CNA 209 FOREST ST ADVANCED AGED FOX LAKE WI 53933 Stephanie McNicol Gender - Capacity: M/F - 14 (920) 520-0122 Stephanie McNicol 209 FOREST ST Low/High rate: 3,850/4,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE FOX LAKE WI 53933 Initial License: 01/21/2016 PUBLIC FUNDING TERMINALLY ILL Association Approval: WALA

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 32 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ARCADIA COMMUNITIES (0013631) ARCADIA COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (920) 387-5840 Class: CNA 911 S CENTER ST ADVANCED AGED BEAVER DAM WI 53916 ROGER THIMM Gender - Capacity: M/F - 20 (920) 219-9517 JONATHAN MOYER W2874 GRAYLOG RD Low/High rate: 3,500/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE IRON RIDGE WI 53035 Initial License: 04/01/2011 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL ARCADIA COMMUNITIES (0013631) ARCADIA COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (920) 387-5840 Class: CNA 911 S CENTER ST ADVANCED AGED BEAVER DAM WI 53916 ROGER THIMM Gender - Capacity: M/F - 20 (920) 219-9517 JONATHAN MOYER W2874 GRAYLOG RD Low/High rate: 3,500/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE IRON RIDGE WI 53035 Initial License: 04/01/2011 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL ARCADIA COMMUNITIES (0013631) ARCADIA COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (920) 387-5840 Class: CNA 911 S CENTER ST ADVANCED AGED BEAVER DAM WI 53916 ROGER THIMM Gender - Capacity: M/F - 20 (920) 219-9517 JONATHAN MOYER W2874 GRAYLOG RD Low/High rate: 3,500/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE IRON RIDGE WI 53035 Initial License: 04/01/2011 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL CHRISTIAN HOMESTEAD (0009149) CHRISTIAN HOME REHABILITATION CENTER IN Type: CBRF HCBS COMPLIANT (920) 324-9051 Class: CNA 1001 WEST BROWN ST ADVANCED AGED WAUPUN WI 53963 Linzi Gazga Gender - Capacity: M/F - 36 (920) 324-9051 Craig Smith 452 Fox Lake Road Low/High rate: 4,640/4,960 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE WAUPUN WI 53963 Initial License: 12/04/2000 PUBLIC FUNDING TRAUMATIC BRAIN INJURY Association Approval: LeadingAge Wisconsin DAYBREAK INC HORICON (110532) DAYBREAK INC Type: CBRF HCBS COMPLIANT (920) 485-4010 Class: AA 822 E WALNUT ST ALCOHOL/DRUG DEPENDENT HORICON WI 53032 FRANK WILL Gender - Capacity: M/F - 12 (920) 485-4010 FRANK WILL 822 E WALNUT ST Low/High rate: 4,982/5,253 CORRECTIONAL CLIENTS County: DODGE HORICON WI 53032 Initial License: 02/01/1980 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING DAYBREAK INC WAUPUN (110539) DAYBREAK INC Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 485-4010 Class: AA 631 S MADISON ST CORRECTIONAL CLIENTS WAUPUN WI 53963 FRANK WILL Gender - Capacity: M/F - 8 (920) 324-4903 FRANK WILL 631 S MADISON ST Low/High rate: 6,165/6,165 DEVELOPMENTALLY DISABLED County: DODGE WAUPUN WI 53963 Initial License: 01/01/1995 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING EAGLES WINGS (111039) BEAVER DAM COMMUNITY HOSPITALS INC Type: CBRF HCBS COMPLIANT (920) 887-5902 Class: CNA 408 STONE ST ADVANCED AGED BEAVER DAM WI 53916 TRICIA WEISNICHT Gender - Capacity: M/F - 22 (920) 885-9700 KATHY BATES 707 S UNIVERSITY AVE Low/High rate: 3,710/4,263 PUBLIC FUNDING County: DODGE BEAVER DAM WI 53916 Initial License: 09/08/1997 Association Approval: LeadingAge Wisconsin EVERGREEN MANOR III INC (0011807) EVERGREEN MANOR III INC Type: CBRF HCBS COMPLIANT (920) 229-3664 Class: AA 239 VICTORY ST DEVELOPMENTALLY DISABLED JUNEAU WI 53039 JIM ROSIN Gender - Capacity: M/F - 8 (920) 386-9012 CINDY WEISENSEL PO BOX 900 Low/High rate: 3,000/3,900 EMOTIONALLY DISTURBED/MENTAL County: DODGE WAUTOMA WI 54982 Initial License: 02/19/2007 PUBLIC FUNDING GOLDEN YEARS OF RANDOLPH I (0016892) DR-GY LLC Type: CBRF ADVANCED AGED (608) 712-8264 Class: CNA 131 ELLIS AVE EMOTIONALLY DISTURBED/MENTAL RANDOLPH WI 53956 Rocky Everyly Gender - Capacity: M/F - 9 (920) 326-4663 Rebecca Henne 747 Lois Drive Low/High rate: 3,200/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE Sun Prairie WI 53184 Initial License: 11/01/2018 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 33 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

GOLDEN YEARS OF RANDOLPH II (0016893) DR-GY LLC Type: CBRF ADVANCED AGED (608) 217-2810 Class: CNA 137 ELLIS AVE EMOTIONALLY DISTURBED/MENTAL RANDOLPH WI 53956 Rocky Everly Gender - Capacity: M/F - 9 (920) 326-8264 Rebecca Henne 747 Lois Drive Low/High rate: 3,200/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE Sun Prairie WI 53184 Initial License: 11/01/2018 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY HERITAGE ASSISTED LIVING OF WATERTOWN LLC (0017 WATERTOWN LUTHERAN SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (952) 873-4750 Class: CNA 700 WELSH ROAD ADVANCED AGED WATERTOWN WI 53098 BARBARA BUTLER Gender - Capacity: M/F - 46 (920) 567-2001 BARBARA BUTLER 700 WELSH ROAD Low/High rate: 4,991/6,077 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE WATERTOWN WI 53098 Initial License: 06/01/2020 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: LeadingAge Wisconsin HIGHLAND HOUSE (0015792) WATERTOWN MEDICAL CENTER LLC Type: CBRF ADVANCED AGED (615) 920-7000 Class: CNA 125A HOSPITAL DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM WATERTOWN WI 53098 Amy Lillge Gender - Capacity: M/F - 20 (920) 262-4823 BROOKE FUCHS 125 HOSPITAL DRIVE Low/High rate: 3,890/5,200 TERMINALLY ILL County: DODGE WATERTOWN WI 53098 Initial License: 09/01/2015 HIL MEADOWBROOK (0011747) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 1405 WEDGEWOOD CRT DEVELOPMENTALLY DISABLED WATERTOWN WI 53098 Ashley Williams Gender - Capacity: M/F - 7 (262) 390-2087 Sara Stachel-Wagner 1249 RUSSETT COURT Low/High rate: 5,990/5,990 PUBLIC FUNDING County: DODGE GREEN BAY WI 54313 Initial License: 12/21/2006 MARVINS MANOR II (0012372) MARVINS MANOR LLC Type: CBRF HCBS COMPLIANT (920) 324-5359 Class: CNA 839 DIVISION ST ADVANCED AGED HORICON WI 53032 BARBARA HENDRICKS Gender - Capacity: M/F - 22 (920) 485-4016 BARBARA HENDRICKS 839 DIVISION ST Low/High rate: 3,050/3,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE HORICON WI 53032 Initial License: 09/08/2008 TERMINALLY ILL NORTHVIEW HEIGHTS (0014709) DODGE COUNTY Type: CBRF ADVANCED AGED (920) 386-3600 Class: CNA 199 CTY DF DEVELOPMENTALLY DISABLED JUNEAU WI 53039 Ed Somers Gender - Capacity: M/F - 20 (920) 386-4257 Ed Somers 198 CTY DF Low/High rate: 3,348/6,712 EMOTIONALLY DISTURBED/MENTAL County: DODGE JUNEAU WI 53039 Initial License: 11/11/2013 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY Association Approval: LeadingAge Wisconsin PARK RIDGE (110538) ZINZENDORF HALL INC Type: CBRF HCBS COMPLIANT (920) 261-5655 Class: CNA 1148 BAYBERRY DR ADVANCED AGED WATERTOWN WI 53098 JENNIFER JOHNSON Gender - Capacity: M/F - 48 (920) 261-5655 JENNIFER JOHNSON 1045 HILL ST Low/High rate: 5,507/7,082 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE WATERTOWN WI 53098 Initial License: 11/16/1989 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin PARK TERRACE (0016164) ZINZENDORF HALL INC Type: CBRF ADVANCED AGED (920) 261-0400 Class: CNA 1047 HILL STREET IRREVERSIBLE DEMENTIA/ALZHEIM WATERTOWN WI 53098 JENNIFER JOHNSON Gender - Capacity: M/F - 44 (608) 852-5585 JENNIFER JOHNSON 1045 HILL STREET Low/High rate: 5,876/7,400 County: DODGE WATERTOWN WI 53098 Initial License: 08/04/2016 Association Approval: LeadingAge Wisconsin PRAIRIE RIDGE ASSISTED LIVING (0012604) ADVANTAGE MANAGEMENT WAUPUN LLC Type: CBRF ADVANCED AGED (920) 350-6001 Class: CNA 819 WILCOX ST IRREVERSIBLE DEMENTIA/ALZHEIM WAUPUN WI 53963 MICHAEL EISENGA Gender - Capacity: M/F - 24 (920) 324-5450 Bledsoe Angela N4365 STATE HWY 73 Low/High rate: 3,450/4,995 County: DODGE COLUMBUS WI 53925 Initial License: 12/02/2008

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 34 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PRAIRIE RIDGE ASSISTED LIVING (0012224) ADVANTAGE MANAGEMENT BEAVER DAM LLC Type: CBRF ADVANCED AGED (920) 350-6001 Class: CNA 212 EAST INDUSTRIAL DR IRREVERSIBLE DEMENTIA/ALZHEIM BEAVER DAM WI 53916 MICHAEL EISENGA Gender - Capacity: M/F - 34 (920) 356-0032 Rebecca Maas N4365 HWY 73 Low/High rate: 3,550/4,995 County: DODGE COLUMBUS WI 53925 Initial License: 04/15/2008 REMEMBRANCE HOME (0009159) BEAVER DAM COMMUNITY HOSPITALS INC Type: CBRF HCBS COMPLIANT (920) 887-5902 Class: CNA 1810 N SPRING ST IRREVERSIBLE DEMENTIA/ALZHEIM BEAVER DAM WI 53916 KATHY BATES Gender - Capacity: M/F - 19 (920) 356-9015 KATHY BATES 1810 NORTH SPRING STREET Low/High rate: 4,560/4,810 PUBLIC FUNDING County: DODGE BEAVER DAM WI 53916 Initial License: 12/22/2000 Association Approval: LeadingAge Wisconsin RESCARE STONERIDGE (0016943) RESCARE RESIDENTIAL SERVICES WISCONSIN Type: CBRF HCBS COMPLIANT (502) 394-2100 Class: CNA 1502 STONERIDGE CT DEVELOPMENTALLY DISABLED WATERTOWN WI 53098 KrIsty Fletcher Gender - Capacity: M/F - 6 (920) 390-2139 Nicole McMillan 383 Williamstowne Suite 201 Low/High rate: 5,207/5,785 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE Delafield WI 53018 Initial License: 11/01/2017 TRAUMATIC BRAIN INJURY SYLVAN CROSSINGS AT HUNTER RIDGE (111056) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 626 MONROE ST ADVANCED AGED BEAVER DAM WI 53916 DANIEL FLEMING Gender - Capacity: M/F - 21 (920) 885-1790 Rebakah Lim 2960 TRIVERTON PIKE DR.STE 202 Low/High rate: 3,270/4,460 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE MADISON WI 53711 Initial License: 03/27/1998 PUBLIC FUNDING SYLVAN CROSSINGS AT HUNTER RIDGE (111056) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 626 MONROE ST ADVANCED AGED BEAVER DAM WI 53916 DANIEL FLEMING Gender - Capacity: M/F - 21 (920) 885-1790 Rebakah Lim 2960 TRIVERTON PIKE DR.STE 202 Low/High rate: 3,270/4,460 IRREVERSIBLE DEMENTIA/ALZHEIM County: DODGE MADISON WI 53711 Initial License: 03/27/1998 PUBLIC FUNDING ANNAS HEALTHCARE INC (0014311) TAMA A BEGLEY Type: CBRF HCBS COMPLIANT (920) 366-8856 Class: CNA 839 S 18TH AVE ADVANCED AGED STURGEON BAY WI 54235 TAMA A. BEGLEY Gender - Capacity: M/F - 68 (920) 818-1200 TAMA A BEGLEY 4999 PLACID WAY Low/High rate: 2,350/6,844 DEVELOPMENTALLY DISABLED County: DOOR NEW FRANKEN WI 54229 Initial License: 11/08/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL BAY HARBOR MEMORY CARE & A l OF STURGEON BAY 1 BAY HARBOR ASSISTED LIVING OF STURGEON Type: CBRF HCBS COMPLIANT (608) 561-8510 Class: CNA 1704 GEORGIA STREET ADVANCED AGED STURGEON BAY WI 54235 JONATHAN MOYER Gender - Capacity: M/F - 19 (920) 746-8998 SUSAN LIERMANN 318 SAMUEL DRIVE SUITE 404 Low/High rate: 2,500/11,000 DEVELOPMENTALLY DISABLED County: DOOR MADISON WI 53717 Initial License: 10/01/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BAY HARBOR MEMORY CARE & A L OF STURGEON BAY BAY HARBOR ASSISTED LIVING OF STURGEON Type: CBRF HCBS COMPLIANT (608) 561-8510 Class: CNA 1610 GEORGIA STREET ADVANCED AGED STURGEON BAY WI 54235 JONATHAN MOYER Gender - Capacity: - 19 (920) 746-8998 SUSAN LIERMANN 318 SAMUEL DRIVE SUITE 404 Low/High rate: 2,500/11,000 DEVELOPMENTALLY DISABLED County: DOOR MADISON WI 53717 Initial License: 10/22/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CARDINAL RIDGE RESIDENTIAL CARE (0010030) CARDINAL RIDGE RESIDENTIAL CARE Type: CBRF HCBS COMPLIANT (920) 434-9600 Class: CNA 817 CIRCLE RIDGE PLACE ADVANCED AGED STURGEON BAY WI 54235 ALLIE NEWKIRK Gender - Capacity: M/F - 26 (920) 743-9289 ALLIE NEWKIRK PO BOX 11966 Low/High rate: 3,995/5,570 DEVELOPMENTALLY DISABLED County: DOOR GREEN BAY WI 54307-1966 Initial License: 04/01/2003 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 35 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HEARTHSIDE (410502) CORDIAL CARE CORP Type: CBRF ADVANCED AGED (920) 854-4501 Class: CNA 10569 FIELDCREST RD IRREVERSIBLE DEMENTIA/ALZHEIM SISTER BAY WI 54234 MARTHA COVENTRY Gender - Capacity: M/F - 15 (920) 854-7225 MARTHA COVENTRY 10569 FIELDCREST RD Low/High rate: 5,000/5,600 TERMINALLY ILL County: DOOR SISTER BAY WI 54234 Initial License: 05/01/1997 WOODVIEW OF SCANDIA (0015318) EVANGELICAL LUTHERAN GOOD SAMARITAN S Type: CBRF HCBS COMPLIANT (920) 362-3109 Class: CNA 2311 MEADOW WOOD DR ADVANCED AGED SISTER BAY WI 54234 MICHELE NOTZ Gender - Capacity: M/F - 30 (920) 854-2317 MICHELE NOTZ 10560 APPLEWOOD RD Low/High rate: 3,723/5,185 IRREVERSIBLE DEMENTIA/ALZHEIM County: DOOR SISTER BAY WI 54234 Initial License: 12/17/2014 PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin BILLINGS PARK CBRF (0017557) ENCOMPASS HEALTHCARE & ASSISTED LIVING Type: CBRF HCBS COMPLIANT (715) 392-2780 Class: AA 1927 OHIO AVE DEVELOPMENTALLY DISABLED SUPERIOR WI 54880 TYLER NYHUS Gender - Capacity: M/F - 7 (715) 392-2780 PATRICIA GLITSOS 1225 TOWER AVE STE 228 Low/High rate: 4,000/10,000 EMOTIONALLY DISTURBED/MENTAL County: DOUGLAS SUPERIOR WI 54880 Initial License: 06/26/2019 PUBLIC FUNDING CEDAR RIDGE ASSISTED LIVING & MEMORY CARE II (001 CEDAR RIDGE ASSISTED LIVING & MEMORY CA Type: CBRF ADVANCED AGED (715) 969-8299 Class: CNA 4527 E MARQUARDT RD IRREVERSIBLE DEMENTIA/ALZHEIM SUPERIOR WI 54880 DEANNA PETERSON Gender - Capacity: M/F - 10 (715) 392-0610 ELIZABETH JOHNSTON 4561 E MARQUARDT RD Low/High rate: 4,000/4,900 County: DOUGLAS SUPERIOR WI 54880 Initial License: 03/03/2014 CYPRESS HOUSE CBRF (510320) CHALLENGE CENTER INC Type: CBRF HCBS COMPLIANT (715) 394-2771 Class: CNA 1415 CYPRESS AVE DEVELOPMENTALLY DISABLED SUPERIOR WI 54880 KELLY PETERSON Gender - Capacity: M/F - 7 (715) 392-8997 KRISTEN BOVEE 39 N 25TH ST EAST Low/High rate: 3,000/4,620 County: DOUGLAS SUPERIOR WI 54880 Initial License: 05/12/1989 DEER HAVEN (510005) CHALLENGE CENTER INC Type: CBRF HCBS COMPLIANT (715) 394-2771 Class: CNA 3105 CUMMING AVE DEVELOPMENTALLY DISABLED SUPERIOR WI 54880 KELLY PETERSON Gender - Capacity: M/F - 7 (715) 392-5427 DANIELLE PAULUS 39 N 25TH ST EAST Low/High rate: 2,914/5,146 County: DOUGLAS SUPERIOR WI 54880 Initial License: 10/19/1981 ENCOMPASS HEALTHCARE ASSISTED LIVING (0013168) ENCOMPASS HEALTHCARE & ASSISTED LIVING Type: CBRF HCBS COMPLIANT (715) 392-2780 Class: CNA 1500 N 34TH ST STE 600 ADVANCED AGED SUPERIOR WI 54880 TYLER NYHUS Gender - Capacity: M/F - 14 (715) 392-2780 PATRICIA GLITSOS 1225 TOWER AVE STE 228 Low/High rate: 3,800/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DOUGLAS SUPERIOR WI 54880 Initial License: 03/17/2010 PUBLIC FUNDING FAXON HOUSE (0013794) ENCOMPASS HEALTHCARE & ASSISTED LIVING Type: CBRF HCBS COMPLIANT (715) 392-2780 Class: AA 1212 FAXON STREET EMOTIONALLY DISTURBED/MENTAL SUPERIOR WI 54880 TYLER NYHUS Gender - Capacity: M/F - 7 (715) 395-3733 MARIA NYHUS 1225 TOWER AVENUE SUITE 228 Low/High rate: 4,000/10,000 PUBLIC FUNDING County: DOUGLAS SUPERIOR WI 54880 Initial License: 07/29/2011 HARBORVIEW CBRF (510321) CHALLENGE CENTER INC Type: CBRF HCBS COMPLIANT (715) 394-2771 Class: AA 910 E 5TH ST DEVELOPMENTALLY DISABLED SUPERIOR WI 54880 KELLY PETERSON Gender - Capacity: M/F - 7 (715) 394-3226 GEORGE HIRVELA 39 N 25TH ST E Low/High rate: 3,096/3,410 County: DOUGLAS SUPERIOR WI 54880 Initial License: 01/03/1989 HARMONY HOUSE I (0016728) HARMONY KC LLC Type: CBRF HCBS COMPLIANT (715) 392-7615 Class: CNA 7615 JOHN AVE ADVANCED AGED SUPERIOR WI 54880 SHARON KOTTER Gender - Capacity: M/F - 8 (715) 395-7615 SHARON KOTTER 7615 JOHN AVE Low/High rate: 2,585/4,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: DOUGLAS SUPERIOR WI 54880 Initial License: 06/15/2017 HARMONY HOUSE II (0016729) HARMONY KC LLC Type: CBRF HCBS COMPLIANT (715) 392-7615 Class: CNA 7613 JOHN AVE ADVANCED AGED SUPERIOR WI 54880 SHARON KOTTER Gender - Capacity: M/F - 8 (715) 392-7644 SHARON KOTTER 7615 JOHN AVE Low/High rate: 3,815/5,270 IRREVERSIBLE DEMENTIA/ALZHEIM County: DOUGLAS SUPERIOR WI 54880 Initial License: 06/15/2017

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 36 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MCKENZIE MANOR (0009412) CHALLENGE CENTER INC Type: CBRF HCBS COMPLIANT (715) 394-2771 Class: CNA 3317 NORTH 21ST STREET DEVELOPMENTALLY DISABLED SUPERIOR WI 54880 KELLY PETERSON Gender - Capacity: M/F - 7 (715) 399-0900 KELLY PETERSON 39 NORTH 25TH STREET EAST Low/High rate: 4,802/8,265 County: DOUGLAS SUPERIOR WI 54880 Initial License: 09/07/2001 MOUNTAIN VIEW HOME (0009539) CHALLENGE CENTER INC Type: CBRF HCBS COMPLIANT (715) 394-2771 Class: CNA 3319 N 16TH STREET DEVELOPMENTALLY DISABLED SUPERIOR WI 54880 KELLY PETERSON Gender - Capacity: M/F - 6 (715) 392-3038 SHANNON HIRVELA 39 N 25TH ST E Low/High rate: 4,047/8,876 County: DOUGLAS SUPERIOR WI 54880 Initial License: 02/26/2002 NEW PERSPECTIVE SUPERIOR (0013514) SUPERIOR OPS LLC Type: CBRF HCBS COMPLIANT (218) 721-2800 Class: CNA 1915 N 34TH ST ADVANCED AGED SUPERIOR WI 54880 RYAN NOVACZYK Gender - Capacity: M/F - 44 (715) 399-3300 JEFFERY BERGUM 5900 CLEARWATER DRIVE STE 500 Low/High rate: 4,850/6,066 IRREVERSIBLE DEMENTIA/ALZHEIM County: DOUGLAS MINNETONKA MN 55343 Initial License: 11/11/2010 NEW PERSPECTIVE SUPERIOR (0013514) SUPERIOR OPS LLC Type: CBRF HCBS COMPLIANT (218) 721-2800 Class: CNA 1915 N 34TH ST ADVANCED AGED SUPERIOR WI 54880 RYAN NOVACZYK Gender - Capacity: M/F - 44 (715) 399-3300 JEFFERY BERGUM 5900 CLEARWATER DRIVE STE 500 Low/High rate: 4,850/6,066 IRREVERSIBLE DEMENTIA/ALZHEIM County: DOUGLAS MINNETONKA MN 55343 Initial License: 11/11/2010 NEW PERSPECTIVE SUPERIOR (0013514) SUPERIOR OPS LLC Type: CBRF HCBS COMPLIANT (218) 721-2800 Class: CNA 1915 N 34TH ST ADVANCED AGED SUPERIOR WI 54880 RYAN NOVACZYK Gender - Capacity: M/F - 44 (715) 399-3300 JEFFERY BERGUM 5900 CLEARWATER DRIVE STE 500 Low/High rate: 4,850/6,066 IRREVERSIBLE DEMENTIA/ALZHEIM County: DOUGLAS MINNETONKA MN 55343 Initial License: 11/11/2010 NEW PERSPECTIVE SUPERIOR (0013514) SUPERIOR OPS LLC Type: CBRF HCBS COMPLIANT (218) 721-2800 Class: CNA 1915 N 34TH ST ADVANCED AGED SUPERIOR WI 54880 RYAN NOVACZYK Gender - Capacity: M/F - 44 (715) 399-3300 JEFFERY BERGUM 5900 CLEARWATER DRIVE STE 500 Low/High rate: 4,850/6,066 IRREVERSIBLE DEMENTIA/ALZHEIM County: DOUGLAS MINNETONKA MN 55343 Initial License: 11/11/2010 Association Approval: WALA NORTHERN RESIDENCE (0015460) NORTHERN RESIDENCE LLC Type: CBRF HCBS COMPLIANT (715) 374-2274 Class: CS 6857 S CTY RD E ADVANCED AGED HAWTHORNE WI 54842 KEVIN DOTY Gender - Capacity: M/F - 7 (715) 374-3358 ATHENA DABATO DOTY PO BOX 160 Low/High rate: 3,800/6,500 PUBLIC FUNDING County: DOUGLAS HAWTHORNE WI 54842 Initial License: 01/15/2015 REM WISCONSIN III INC 21ST STREET (0009561) REM WISCONSIN INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA 3901 N 21ST STREET ADVANCED AGED SUPERIOR WI 54880 LORI WRIGHT Gender - Capacity: M/F - 6 (715) 395-2821 SARAH PLACHTA 4033 123rd ST, STE A Low/High rate: 4,050/5,640 DEVELOPMENTALLY DISABLED County: DOUGLAS CHIPPEWA WI 54729 Initial License: 03/19/2002 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING REM WISCONSIN III INC BELKNAP (0009560) REM WISCONSIN INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA 3706 BELKNAP ST ADVANCED AGED SUPERIOR WI 54880 LORI WRIGHT Gender - Capacity: M/F - 6 (715) 395-2815 SARAH PLACHTA 4033 123rd ST, STE A Low/High rate: 3,996/6,045 DEVELOPMENTALLY DISABLED County: DOUGLAS CHIPPEWA FALLS WI 54729 Initial License: 03/19/2002 PHYSICALLY DISABLED PUBLIC FUNDING REM WISCONSIN III INC CENTENNIAL (0015614) REM WISCONSIN III INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA 5303 CUMMINGS AVENUE ADVANCED AGED SUPERIOR WI 54880 LORI WRIGHT Gender - Capacity: M/F - 8 (715) 718-0455 SARAH PLACHTA 4033 123 ST, STE A Low/High rate: 4,746/6,392 DEVELOPMENTALLY DISABLED County: DOUGLAS CHIPPEWA FALLS WI 54729 Initial License: 06/04/2015 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING SUNNYSIDE CBRF (0017840) CHALLENGE CENTER INC Type: CBRF HCBS COMPLIANT (715) 394-2771 Class: CNA 7619 JOHN AVE DEVELOPMENTALLY DISABLED SUPERIOR WI 54880 KELLY PETERSON Gender - Capacity: M/F - 6 (715) 398-0512 SHANNON HIRVELA 39 N 25TH ST E Low/High rate: 2,000/9,000 County: DOUGLAS SUPERIOR WI 54880 Initial License: 11/15/2019

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 37 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

TRADEWINDS RESIDENCE INC (510325) TRADEWINDS RESIDENCE INC Type: CBRF ALCOHOL/DRUG DEPENDENT (218) 728-9295 Class: AS 1601 N 16TH ST CORRECTIONAL CLIENTS SUPERIOR WI 54880 JOHN KOLAR Gender - Capacity: M/F - 20 (715) 394-2077 JOHN KOLAR 1601 NORTH 16TH STREET Low/High rate: 3,954/4,028 EMOTIONALLY DISTURBED/MENTAL County: DOUGLAS SUPERIOR WI 54880 Initial License: 05/13/1994 PUBLIC FUNDING ARBOR PLACE INC (0015712) ARBOR PLACE INC Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 235-4537 Class: ANA 4076 KOTHLOW AVENUE PUBLIC FUNDING MENOMONIE WI 54751 JILL GAMEZ Gender - Capacity: M/F - 32 (715) 235-4537 JILL GAMEZ 4076 KOTHLOW AVENUE Low/High rate: 2,910/7,750 County: DUNN MENOMONIE WI 54751 Initial License: 06/18/2015 AURORA RES ALTERNATIVES INC 011 (0009573) AURORA RESIDENTIAL ALTERNATIVES INC Type: CBRF HCBS COMPLIANT (715) 235-1839 Class: CNA 1306 12TH AVENUE SE DEVELOPMENTALLY DISABLED MENOMONIE WI 54751 DEENA BLACK Gender - Capacity: M/F - 8 (715) 233-1299 JUSTIN BOITEAU P O BOX 68 Low/High rate: 3,832/6,016 EMOTIONALLY DISTURBED/MENTAL County: DUNN MENOMONIE WI 54751 Initial License: 03/01/2002 PUBLIC FUNDING TRAUMATIC BRAIN INJURY AURORA RESIDENTIAL ALT INC 010 (0011477) AURORA RESIDENTIAL ALTERNATIVES INC Type: CBRF HCBS COMPLIANT (715) 235-1839 Class: CNA 2412 THIRD ST E DEVELOPMENTALLY DISABLED MENOMONIE WI 54751 DEENA BLACK Gender - Capacity: M/F - 6 (715) 235-0290 JUSTIN BOITEAU P O BOX 68 Low/High rate: 5,279/7,556 PUBLIC FUNDING County: DUNN MENOMONIE WI 54751 Initial License: 06/19/2006 CARE PARTNERS MENOMONIE (0009882) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1902 TALEN ST ADVANCED AGED MENOMONIE WI 54751 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 235-6333 CRYSTAL ULBERG P O BOX 3006 Low/High rate: 2,600/4,050 IRREVERSIBLE DEMENTIA/ALZHEIM County: DUNN OSHKOSH WI 54903-3006 Initial License: 10/01/2002 PHYSICALLY DISABLED TERMINALLY ILL COMFORTS OF HOME MENOMONIE CBRF (0013677) MENOMONIE CBRF, LLC Type: CBRF HCBS COMPLIANT (651) 287-0265 Class: CNA 2211 WHITE PINE LANE ADVANCED AGED MENOMONIE WI 54751 RHONDA SCHILLINGER Gender - Capacity: M/F - 30 (715) 231-3020 MELINDA JOHNSON 750 MAIN STREET, SUITE 200 Low/High rate: 4,500/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: DUNN MENDOTA HEIGHTS MN 55118 Initial License: 04/01/2011 PUBLIC FUNDING COUNTRY TERRACE MENOMONIE (0009880) COUNTRY TERRACE OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1916 TALEN ST ADVANCED AGED MENOMONIE WI 54751 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 235-5112 CRYSTAL ULBERG PO BOX 3006 Low/High rate: 2,652/3,702 IRREVERSIBLE DEMENTIA/ALZHEIM County: DUNN OSHKOSH WI 54903-3006 Initial License: 08/07/2003 PUBLIC FUNDING TERMINALLY ILL GRATUS AT RIDGEWOOD (0017682) MIDWEST GRATUS INC Type: CBRF HCBS COMPLIANT (715) 861-5320 Class: CNA 2379 RIDGEWOOD ST ADVANCED AGED MENOMONIE WI 54751 SANDRA JOHNSON-ERICKSEN Gender - Capacity: M/F - 8 (715) 309-4179 MATTEA LUTZ PO BOX 159 Low/High rate: 3,965/9,900 ALCOHOL/DRUG DEPENDENT County: DUNN MENOMONIE WI 54751 Initial License: 10/01/2019 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY NOREEN FAMILY HOME (0010740) NOREEN FAMILY HOMES, INC Type: CBRF HCBS COMPLIANT (715) 308-4500 Class: CS 2913 INGALLS RD ADVANCED AGED MENOMONIE WI 54751 DEANNA EBERT Gender - Capacity: M/F - 8 (715) 235-4657 DEANNA EBERT E5901 - 800TH AVE Low/High rate: 2,650/2,650 DEVELOPMENTALLY DISABLED County: DUNN MENOMONIE WI 54751 Initial License: 12/06/2004 OUR HOUSE MENOMONIE MEMORY CARE (0013428) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 820 17TH AVENUE ADVANCED AGED MENOMONIE WI 54751 LORI NARDIN Gender - Capacity: M/F - 19 (715) 232-8181 ALISHA ARVOLD 4350 156TH STREET Low/High rate: 4,375/4,425 IRREVERSIBLE DEMENTIA/ALZHEIM County: DUNN CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 38 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

POTTERS COUNTRY HOME (0010954) POTTERS COUNTRY HOME Type: CBRF HCBS COMPLIANT (715) 505-0621 Class: AS N3430 STATE RD 25 ADVANCED AGED MENOMONIE WI 54751 RACHEL SELCHOW Gender - Capacity: M/F - 15 (715) 505-0621 RACHEL SELCHOW N3426 STATE HWY 25 Low/High rate: 2,700/3,300 PUBLIC FUNDING County: DUNN MENOMONIE WI 54751 Initial License: 08/01/2005 RIDGE CREST MANOR (0014630) COLFAX HEALTH & REHABILITATION CENTER IN Type: CBRF ADVANCED AGED (715) 962-3186 Class: CNA 110 PARK DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM COLFAX WI 54730 KENZIE GALETKA Gender - Capacity: M/F - 28 (715) 962-3186 KENZIE GALETKA 110 PARK DRIVE Low/High rate: 3,975/6,815 PHYSICALLY DISABLED County: DUNN COLFAX WI 54730 Initial License: 07/30/2013 Association Approval: LeadingAge Wisconsin SAFE HAVEN ADULT ASSISTED LIVING LLC (0015032) SAFE HAVEN ADULT ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 977-1828 Class: CNA 421 MAIN STREET ADVANCED AGED BOYCEVILLE WI 54725 TERRA ENGEMAN Gender - Capacity: M/F - 8 (715) 643-7233 TERRA/DENISE ENGEMAN/JESKE 421 MAIN STREET Low/High rate: 4,000/9,000 DEVELOPMENTALLY DISABLED County: DUNN BOYCEVILLE WI 54725 Initial License: 06/01/2014 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY TARA PLACE (510292) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA N5160 97OTH STREET ALCOHOL/DRUG DEPENDENT ELK MOUND WI 54739 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 8 (715) 879-5381 LINDSAY FARRELL-GOVEK 2710 N TOWN HALL RD Low/High rate: 5,753/6,502 DEVELOPMENTALLY DISABLED County: DUNN EAU CLAIRE WI 54703 Initial License: 08/20/1996 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING AFFINITY HOUSE (510031) LUTHERAN SOC SERV OF WI & UPPER MI INC Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 834-2046 Class: AA 3042 KILBOURNE AVENUE CORRECTIONAL CLIENTS EAU CLAIRE WI 54703 PAULA UPP Gender - Capacity: F - 18 (715) 833-0436 ANITA KUSTER 3003 N RICHMOND ST Low/High rate: 1,598/1,598 County: EAU CLAIRE APPLETON WI 54911 Initial License: 04/01/1988 APPLE TREE COTTAGE CBRF (0013306) THOMAS C KITE Type: CBRF HCBS COMPLIANT (715) 835-4764 Class: AA 1306 KEITH ST ADVANCED AGED EAU CLAIRE WI 54701 THOMAS KITE Gender - Capacity: M/F - 8 (715) 577-8506 THOMAS KITE S8080 GOLF VIEW DRIVE Low/High rate: 1,980/6,740 DEVELOPMENTALLY DISABLED County: EAU CLAIRE EAU CLAIRE WI 54701 Initial License: 05/21/2010 TRAUMATIC BRAIN INJURY AZURA MEMORY CARE OF EAU CLAIRE 2 LLC (0017542) AZURA EAU CLAIRE 2 LLC Type: CBRF HCBS COMPLIANT (920) 284-6682 Class: CNA 4811 BULLIS FARM RD ADVANCED AGED EAU CLAIRE WI 54701 JILL KREIDER Gender - Capacity: M/F - 24 NICOLE WEBER 1233 N MAYFAIR RD STE 301 Low/High rate: 3,850/7,975 IRREVERSIBLE DEMENTIA/ALZHEIM County: EAU CLAIRE MILWAUKEE WI 53226 Initial License: 05/24/2019 BEEHIVE HOMES OF EAU CLAIRE (0016672) DCIJ BEE HIVE LLC Type: CBRF HCBS COMPLIANT (715) 834-0842 Class: CNA 5075 STONEWOOD DR ADVANCED AGED EAU CLAIRE WI 54703 DANIEL PEKOL Gender - Capacity: M/F - 20 (715) 834-0842 JAMIE SMITH 5075 STONEWOOD DR Low/High rate: 5,200/6,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 01/05/2018 CARE PARTNERS ASSISTED LIVING ALTOONA I (0016157 CARE PARTNERS ASSISTED LLC Type: CBRF ADVANCED AGED (920) 232-1672 Class: CNA 887 BRIAR LANE IRREVERSIBLE DEMENTIA/ALZHEIM ALTOONA WI 54720 JASON LINDEMANN Gender - Capacity: M/F - 20 (920) 232-1672 AMANDA WAGNER PO BOX 3006 Low/High rate: 4,700/5,600 PHYSICALLY DISABLED County: EAU CLAIRE OSHKOSH WI 54903 Initial License: 06/20/2016 TERMINALLY ILL CARE PARTNERS ASSISTED LIVING ALTOONA II (0016158 CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 893 BRIAR LANE ADVANCED AGED ALTOONA WI 54720 JASON LINDEMANN Gender - Capacity: M/F - 20 (920) 232-1672 AMANDA WAGNER PO BOX 3006 Low/High rate: 4,700/5,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: EAU CLAIRE OSHKOSH WI 54903 Initial License: 06/20/2016 PHYSICALLY DISABLED TERMINALLY ILL CARE PARTNERS ASSISTED LIVING EAU CLAIRE EAST (0 CARE PARTNERS ASSISTED LIVING Type: CBRF HCBS COMPLIANT (920) 232-1472 Class: CNA 3325 BIRCH STREET ADVANCED AGED EAU CLAIRE WI 54701 JASON LINDEMANN Gender - Capacity: M/F - 34 (920) 232-1472 ROBIN HELLAND PO BOX 3006 Low/High rate: 4,500/4,900 PHYSICALLY DISABLED County: EAU CLAIRE OSHKOSH WI 54903 Initial License: 12/20/2013 TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 39 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CARE PARTNERS ASSISTED LIVING EAU CLAIRE EAST II CARE PARTNERS ASSISTED LIVING Type: CBRF HCBS COMPLIANT (920) 232-7672 Class: CNA 3337 BIRCH STREET ADVANCED AGED EAU CLAIRE WI 54703 JASON LINDEMANN Gender - Capacity: M/F - 20 (920) 232-1672 ROBIN HELLAND PO BOX 3006 Low/High rate: 4,700/5,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: EAU CLAIRE OSHKOSH WI 54903 Initial License: 08/25/2014 PHYSICALLY DISABLED TERMINALLY ILL CARE PARTNERS EAU CLAIRE WEST (0017206) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (920) 232-1672 Class: CNA 5110 STONEWOOD DR IRREVERSIBLE DEMENTIA/ALZHEIM EAU CLAIRE WI 54703 JASON LINDEMANN Gender - Capacity: M/F - 60 (920) 999-9999 MEGAN BAER PO BOX 3006 Low/High rate: 4,500/5,600 PHYSICALLY DISABLED County: EAU CLAIRE OSHKOSH WI 54903 Initial License: 08/27/2018 TERMINALLY ILL CLASSIC AT HILLCREST GREENS MEMORY CARE (THE) ( THE CLASSIC AT HILLCREST GREENS LLC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM 2455 SAWGRASS PLACE (715) 839-0200 Class: CNA ALTOONA WI 54720 GREG SPINDLER Gender - Capacity: M/F - 40 (715) 839-0200 GREG SPINDLER 2455 SAWGRASS PLACE Low/High rate: 5,100/9,350 County: EAU CLAIRE ALTOONA WI 54720 Initial License: 07/01/2015 DOVE HEALTHCARE SOUTH ASSISTED LIVING (0016670) HALCYON HEALTHCARE LLC Type: CBRF ADVANCED AGED 3656 MALL DR (423) 227-5957 Class: CNA EAU CLAIRE WI 54701 ASHLEY SMETANA Gender - Capacity: M/F - 16 (715) 552-1035 ASHLEY SMETANA 3656 MALL DR Low/High rate: 3,500/4,000 County: EAU CLAIRE EAU CLAIRE WI 54701 Initial License: 09/18/2017 Association Approval: LeadingAge Wisconsin FAHRMAN CENTER (510019) LUTHERAN SOC SERV OF WI & UPPER MI Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 834-2046 Class: AA 3136 CRAIG ROAD CORRECTIONAL CLIENTS EAU CLAIRE WI 54701 PAULA UPP Gender - Capacity: M/F - 42 (715) 835-9110 SONJA ROPER 3003 N RICHMOND STREET Low/High rate: 3,545/4,763 County: EAU CLAIRE APPLETON WI 54911 Initial License: 08/31/1987 FAMILY TREE (510296) PAMELA SMITH Type: CBRF HCBS COMPLIANT (715) 834-8098 Class: CS 2005 AGNES STREET ADVANCED AGED EAU CLAIRE WI 54701 PAMELA E SMITH Gender - Capacity: M/F - 8 (715) 832-3663 PAMELA SMITH 2005 AGNES STREET Low/High rate: 2,500/4,500 DEVELOPMENTALLY DISABLED County: EAU CLAIRE EAU CLAIRE WI 54701 Initial License: 06/01/1996 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING GRACE EDGEWOOD (510138) GRACE LUTHERAN FOUNDATION INC Type: CBRF HCBS COMPLIANT (715) 832-3003 Class: CNA 2512 SPOONER AVE ADVANCED AGED ALTOONA WI 54720 CAMILLE ATCHISON Gender - Capacity: M/F - 50 (715) 832-5813 CAMILLE ATCHISON P O BOX 287 Low/High rate: 3,100/7,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: EAU CLAIRE EAU CLAIRE WI 54702-0287 Initial License: 04/15/1986 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin GRACE WOODLANDS (0012384) GRACE LUTHERAN FOUNDATION INC Type: CBRF HCBS COMPLIANT (715) 832-3002 Class: CNA 3214 GALA ST ADVANCED AGED EAU CLAIRE WI 54703 JAMIE LARSON Gender - Capacity: M/F - 34 (715) 831-8100 JAMIE LARSON P O BOX 287 Low/High rate: 5,150/7,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: EAU CLAIRE EAU CLAIRE WI 54702-0287 Initial License: 05/01/2008 Association Approval: LeadingAge Wisconsin HEATHERWOOD CBRF (0016083) CSL EAU CLAIRE LLC Type: CBRF HCBS COMPLIANT (541) 636-3460 Class: CNA 4510 GATEWAY DR ADVANCED AGED EAU CLAIRE WI 54701 WILL FORSYTH Gender - Capacity: M/F - 8 (715) 552-5511 MIKE PHLIIPS 1580 VALLEY RIVER DR STE 260 Low/High rate: 6,495/6,995 IRREVERSIBLE DEMENTIA/ALZHEIM County: EAU CLAIRE EUGENE OR 97401 Initial License: 04/11/2016 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA HERITAGE COURT (0011976) HERITAGE-5 LLC Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA 3515 E HAMILTON AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM EAU CLAIRE WI 54701 MILO PINKERTON Gender - Capacity: M/F - 36 (715) 831-8200 SARA STARCK 7901 W NATIONAL AVENUE Low/High rate: 4,150/6,900 PUBLIC FUNDING County: EAU CLAIRE WEST ALLIS WI 53214 Initial License: 11/01/2007

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 40 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HERITAGE COURT (0011976) HERITAGE-5 LLC Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA 3515 E HAMILTON AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM EAU CLAIRE WI 54701 MILO PINKERTON Gender - Capacity: M/F - 36 (715) 831-8200 SARA STARCK 7901 W NATIONAL AVENUE Low/High rate: 4,150/6,900 PUBLIC FUNDING County: EAU CLAIRE WEST ALLIS WI 53214 Initial License: 11/01/2007 HERITAGE COURT (0011976) HERITAGE-5 LLC Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA 3515 E HAMILTON AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM EAU CLAIRE WI 54701 MILO PINKERTON Gender - Capacity: M/F - 36 (715) 831-8200 SARA STARCK 7901 W NATIONAL AVENUE Low/High rate: 4,150/6,900 PUBLIC FUNDING County: EAU CLAIRE WEST ALLIS WI 53214 Initial License: 11/01/2007 HERITAGE COURT (0011976) HERITAGE-5 LLC Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA 3515 E HAMILTON AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM EAU CLAIRE WI 54701 MILO PINKERTON Gender - Capacity: M/F - 36 (715) 831-8200 SARA STARCK 7901 W NATIONAL AVENUE Low/High rate: 4,150/6,900 PUBLIC FUNDING County: EAU CLAIRE WEST ALLIS WI 53214 Initial License: 11/01/2007 LIBERTY VIEW (510042) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA 611 MAIN ST EMOTIONALLY DISTURBED/MENTAL EAU CLAIRE WI 54701 Lindsay Farrell-Govek Gender - Capacity: M/F - 8 (715) 833-8806 LINDSAY FARRELL-GOVEK 2710 N Town Hall Road Low/High rate: 6,263/6,741 PUBLIC FUNDING County: EAU CLAIRE Eau Claire WI 54703 Initial License: 02/01/1984 MARSTON GROUP HOME (0008905) THOMAS C KITE Type: CBRF HCBS COMPLIANT (715) 835-4764 Class: AA 403 MARSTON STREET DEVELOPMENTALLY DISABLED EAU CLAIRE WI 54701 THOMAS KITE Gender - Capacity: M/F - 8 (715) 835-0323 LYNN HOEHN-OLSON S8080 GOLF VIEW DRIVE Low/High rate: 3,550/5,670 County: EAU CLAIRE EAU CLAIRE WI 54701 Initial License: 02/04/2000 MCCORMICK FAMILY CIRCLE (0010592) ANDREW MCCORMICK Type: CBRF HCBS COMPLIANT (715) 833-9592 Class: AA 1018 GRAHAM AVE DEVELOPMENTALLY DISABLED EAU CLAIRE WI 54701 ANDREW MCCORMICK Gender - Capacity: F - 8 (715) 833-9592 ANDREW MCCORMICK 1018 GRAHAM AVE Low/High rate: 1,423/1,620 County: EAU CLAIRE EAU CLAIRE WI 54701 Initial License: 06/01/2004 MILESTONE SENIOR LIVING RENEE (0017057) ABILIT HOLDINGS EAU CLAIRE LLC Type: CBRF ADVANCED AGED (858) 500-6793 Class: CNA 5510 RENEE DR IRREVERSIBLE DEMENTIA/ALZHEIM EAU CLAIRE WI 54703 KAREN SCHACHT Gender - Capacity: M/F - 26 (715) 874-4232 JESSICA LAUER 208 35TH ST DRIVE SE STE 500 Low/High rate: 5,100/6,900 County: EAU CLAIRE CEDAR RAPIDS IA 52403-1361 Initial License: 05/18/2018 MORNING VIEW II (510164) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA 440 SUNDAY DRIVE ALCOHOL/DRUG DEPENDENT ALTOONA WI 54720 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 8 (715) 514-2000 LINDSAY FARRELL-GOVEK 2710 N TOWNHALL RD Low/High rate: 8,070/9,308 DEVELOPMENTALLY DISABLED County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 02/08/1989 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING OAK VIEW II (510040) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA S10580 CO HWY B PO BOX 115 DEVELOPMENTALLY DISABLED ELEVA WI 54738 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 5 (715) 835-6970 LINDSAY FARRELL-GOVEK 2710 N TOWN HALL RD Low/High rate: 6,913/7,781 EMOTIONALLY DISTURBED/MENTAL County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 07/09/1984 PUBLIC FUNDING ORCHARD HILLS (510381) MEADOWLARK HEALTH SERVICES LLC Type: CBRF ADVANCED AGED (715) 552-1030 Class: CNA 1403 TRUAX BLVD PUBLIC FUNDING EAU CLAIRE WI 54703 JONATHAN DRESSLER Gender - Capacity: M/F - 39 (715) 930-6000 JONATHAN DRESSLER 1403 TRUAX BLVD Low/High rate: 3,825/3,825 County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 03/23/1999 ORCHARD HILLS (510381) MEADOWLARK HEALTH SERVICES LLC Type: CBRF ADVANCED AGED (715) 552-1030 Class: CNA 1403 TRUAX BLVD PUBLIC FUNDING EAU CLAIRE WI 54703 JONATHAN DRESSLER Gender - Capacity: M/F - 39 (715) 930-6000 JONATHAN DRESSLER 1403 TRUAX BLVD Low/High rate: 3,825/3,825 County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 03/23/1999 ORCHARD HILLS (510381) MEADOWLARK HEALTH SERVICES LLC Type: CBRF ADVANCED AGED (715) 552-1030 Class: CNA 1403 TRUAX BLVD PUBLIC FUNDING EAU CLAIRE WI 54703 JONATHAN DRESSLER Gender - Capacity: M/F - 39 (715) 930-6000 JONATHAN DRESSLER 1403 TRUAX BLVD Low/High rate: 3,825/3,825 County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 03/23/1999

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 41 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ORCHARD HILLS (510381) MEADOWLARK HEALTH SERVICES LLC Type: CBRF ADVANCED AGED (715) 552-1030 Class: CNA 1403 TRUAX BLVD PUBLIC FUNDING EAU CLAIRE WI 54703 JONATHAN DRESSLER Gender - Capacity: M/F - 39 (715) 930-6000 JONATHAN DRESSLER 1403 TRUAX BLVD Low/High rate: 3,825/3,825 County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 03/23/1999 Association Approval: LeadingAge Wisconsin OUR HOUSE EAU CLAIRE MEMORY CARE (0013430) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 733 W HAMILTON AVE ADVANCED AGED EAU CLAIRE WI 54701 LORI NARDIN Gender - Capacity: M/F - 20 (715) 832-3970 AMY RICHARDS 4350 156TH STREET Low/High rate: 4,840/5,490 IRREVERSIBLE DEMENTIA/ALZHEIM County: EAU CLAIRE CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING PRAIRIE VIEW (510043) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA 6808 W CAMERON ST ALCOHOL/DRUG DEPENDENT EAU CLAIRE WI 54703 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 8 (715) 874-6713 LINDSAY FARRELL-GOVEK 2710 N TOWN HALL RD Low/High rate: 5,859/7,146 DEVELOPMENTALLY DISABLED County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 01/26/1983 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING ROSE VIEW (510209) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: CNA 2710 NORTH TOWN HALL ROAD EMOTIONALLY DISTURBED/MENTAL EAU CLAIRE WI 54703 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 8 (715) 874-6622 Lindsay Farrell-Govek 2710 N TOWN HALL RD Low/High rate: 8,246/9,660 PUBLIC FUNDING County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 10/14/1991 SILVERLEAF OF AUGUSTA (0015922) AUGUSTA AREA HOME INC Type: CBRF ADVANCED AGED 909 BRIDGE CREEK LN (715) 286-2266 Class: CNA AUGUSTA WI 54722 JAHN BRADLEY Gender - Capacity: M/F - 12 (715) 286-2266 JAHN BRADLEY 901 BRIDGE CREEK LANE Low/High rate: 116/157 County: EAU CLAIRE AUGUSTA WI 54722 Initial License: 03/01/2016 TIMBER VIEW (510256) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA S8560 BALSAM ROAD EMOTIONALLY DISTURBED/MENTAL EAU CLAIRE WI 54701 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 6 (715) 878-4699 LINDSAY FARRELL-GOVEK 2710 N TOWN HALL RD Low/High rate: 7,037/7,037 PUBLIC FUNDING County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 12/13/1993 VALLEY VIEW (510064) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA 2720 NORTH TOWNHALL RD EMOTIONALLY DISTURBED/MENTAL EAU CLAIRE WI 54703 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 8 (715) 874-6390 LINDSAY FARRELL-GOVEK 2710 N TOWN HALL RD Low/High rate: 5,859/5,859 PUBLIC FUNDING County: EAU CLAIRE EAU CLAIRE WI 54703 Initial License: 08/01/1985 ADELAIDE PLACE (0015112) LIBERTY FRONTIDA INC Type: CBRF HCBS COMPLIANT (262) 925-9302 Class: CNA 478 W ARNDT ST ADVANCED AGED FOND DU LAC WI 54935 CARIN SCHULTZ Gender - Capacity: M/F - 50 (920) 933-6304 SUSAN OSIER 702 57TH STREET 2ND FLOOR Low/High rate: 3,200/8,000 EMOTIONALLY DISTURBED/MENTAL County: FOND DU LAC KENOSHA WI 53140 Initial License: 07/21/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL ADELAIDE PLACE (0015112) LIBERTY FRONTIDA INC Type: CBRF HCBS COMPLIANT (262) 925-9302 Class: CNA 478 W ARNDT ST ADVANCED AGED FOND DU LAC WI 54935 CARIN SCHULTZ Gender - Capacity: M/F - 50 (920) 933-6304 SUSAN OSIER 702 57TH STREET 2ND FLOOR Low/High rate: 3,200/8,000 EMOTIONALLY DISTURBED/MENTAL County: FOND DU LAC KENOSHA WI 53140 Initial License: 07/21/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA ANCHOR COMMUNITIES II BRANDON (0017190) ANCHOR BRANDON LLC Type: CBRF ADVANCED AGED (920) 470-4008 Class: CNA 603 E CLARK ST IRREVERSIBLE DEMENTIA/ALZHEIM BRANDON WI 53919 STEPHANIE MCNICOL Gender - Capacity: M/F - 14 (920) 346-2322 STEPHANIE MCNICOL 603 E CLARK ST Low/High rate: 3,425/4,250 TERMINALLY ILL County: FOND DU LAC BRANDON WI 53919 Initial License: 05/25/2018

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 42 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ARC FOND DU LAC (410551) ARC COMMUNITY SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 278-2300 Class: AA 27 E THIRD ST 208 CORRECTIONAL CLIENTS FOND DU LAC WI 54935 KAREN KINSEY Gender - Capacity: F - 16 (920) 907-0460 TANIA RHOADS 2001 W BELTLINE HWY STE 102 Low/High rate: 3,103/3,103 County: FOND DU LAC MADISON WI 53713 Initial License: 04/17/1998 ARC PARK AVE GROUP HOME (410005) ARC OF FOND DU LAC INC Type: CBRF HCBS COMPLIANT (920) 923-3810 Class: AA 100 N PARK AVE DEVELOPMENTALLY DISABLED FOND DU LAC WI 54935 JESSICA KIMBALL Gender - Capacity: M/F - 6 (920) 923-3570 JESSICA KIMBALL 500 N PARK AVE Low/High rate: 2,559/2,559 PUBLIC FUNDING County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 09/01/1986 BARRETT HOUSE OF RIPON (0016789) BRIDGET VREDEVELD Type: CBRF ADVANCED AGED (920) 296-8193 Class: CNA 632 HILLTOP LANE DEVELOPMENTALLY DISABLED RIPON WI 54971 BRIDGET VREDEVELD Gender - Capacity: M/F - 15 (920) 748-2999 BRIDGET VREDEVELD 632 HILLTOP LANE Low/High rate: 3,600/4,500 EMOTIONALLY DISTURBED/MENTAL County: FOND DU LAC RIPON WI 54971 Initial License: 09/01/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL BEACON HOUSE (410343) FRIENDS OF WOMEN IN RECOVERY INC Type: CBRF ALCOHOL/DRUG DEPENDENT 166 S PARK AVE (920) 923-3999 Class: AA FOND DU LAC WI 54935 TRACY SCHMIT Gender - Capacity: F - 12 (920) 923-3999 TRACY SCHMIT 166 S PARK AVE Low/High rate: 5,394/5,766 County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 06/01/1993 BETHEL RIPON NORTH (0017977) BA ISRAEL LLC Type: CBRF HCBS COMPLIANT (773) 416-8534 Class: CS 530 NORTH UNION STREET ADVANCED AGED RIPON WI 54971 BRIGHT AMUDOAGHAN Gender - Capacity: M/F - 8 (920) 745-2959 MICHELE PACKETT N9520 SILVER COURT Low/High rate: 5,000/10,000 DEVELOPMENTALLY DISABLED County: FOND DU LAC APPLETON WI 54915 Initial License: 07/22/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BETHEL RIPON SOUTH (0017976) BA ISRAEL LLC Type: CBRF HCBS COMPLIANT (773) 416-8534 Class: CS 530 NORTH UNION STREET ADVANCED AGED RIPON WI 54971 BRIGHT AMUDOAGHAN Gender - Capacity: M/F - 8 (920) 745-2959 MICHELE PACKETT N9520 SILVER COURT Low/High rate: 5,000/10,000 DEVELOPMENTALLY DISABLED County: FOND DU LAC APPLETON WI 54915 Initial License: 07/22/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BLANDINE HOUSE INC (410007) BLANDINE HOUSE INC Type: CBRF ALCOHOL/DRUG DEPENDENT 25 N PARK AVE (920) 922-9487 Class: AA FOND DU LAC WI 54935 JULIE FEILBACH Gender - Capacity: M - 12 (920) 922-9487 JULIE FEILBACH 25 N PARK AVE Low/High rate: 1,820/2,015 County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 02/01/1980 COPPERLEAF VILLAGE OF RIPON (0015836) COPPERLEAF MANAGEMENT GROUP INC Type: CBRF HCBS COMPLIANT (715) 254-4357 Class: CNA 1002 EUREKA ST ADVANCED AGED RIPON WI 54971 KRISTA MENDYKE Gender - Capacity: M/F - 34 (920) 896-0440 JARETT YACH 1077 WILSHIRE BLVD Low/High rate: 3,850/5,850 EMOTIONALLY DISTURBED/MENTAL County: FOND DU LAC STEVENS POINT WI 54481 Initial License: 11/01/2015 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 43 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

FLORIDA (0014656) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 125 GARFIELD ST ADVANCED AGED FOND DU LAC WI 54937 BARB SALEMI Gender - Capacity: M/F - 6 (920) 322-0245 CODY BOELKE 424 WASHINGTON AVE Low/High rate: 3,978/6,347 DEVELOPMENTALLY DISABLED County: FOND DU LAC OSHKOSH WI 54901 Initial License: 09/26/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY FRANKLIN HOUSE (410009) RESIDENTIAL SERVICES INC Type: CBRF HCBS COMPLIANT (920) 922-7072 Class: AS 349 W 11TH ST ADVANCED AGED FOND DU LAC WI 54935 ANN CALNIN Gender - Capacity: M/F - 12 (920) 921-7568 KAYLA LAPALME 342 FOREST AVE Low/High rate: 1,942/2,687 DEVELOPMENTALLY DISABLED County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 02/10/1984 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING LIBERTY HOUSE (0014573) LIBERTY FRONTIDA INC Type: CBRF HCBS COMPLIANT (262) 925-9302 Class: CNA 701 S MAIN ST ADVANCED AGED FOND DU LAC WI 54935 CARIN SCHULTZ Gender - Capacity: M/F - 19 (920) 922-5445 ANGELA LEBLANC 702 57TH STREET 2ND FLOOR Low/High rate: 3,600/8,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC KENOSHA WI 53140 Initial License: 05/15/2013 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL LIBERTY HOUSE (0014573) LIBERTY FRONTIDA INC Type: CBRF HCBS COMPLIANT (262) 925-9302 Class: CNA 701 S MAIN ST ADVANCED AGED FOND DU LAC WI 54935 CARIN SCHULTZ Gender - Capacity: M/F - 19 (920) 922-5445 ANGELA LEBLANC 702 57TH STREET 2ND FLOOR Low/High rate: 3,600/8,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC KENOSHA WI 53140 Initial License: 05/15/2013 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: WALA LINCOLN HOUSE (410289) RESIDENTIAL SERVICES INC Type: CBRF HCBS COMPLIANT (920) 922-7072 Class: CNA 342 FOREST AVE ADVANCED AGED FOND DU LAC WI 54935 ANN CALNIN Gender - Capacity: M/F - 16 (920) 922-9554 KAYLA LAPALME 342 FOREST AVE Low/High rate: 1,985/3,200 DEVELOPMENTALLY DISABLED County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 12/30/1991 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM MAHALAS HOPE (0016193) SANDRA HARDIE Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 904-0444 Class: AA N 4590 HWY 45 PUBLIC FUNDING EDEN WI 53019 KRIS MENDOZA Gender - Capacity: F - 8 (920) 904-6445 SANDRA HARDIE N4590 HWY 45 Low/High rate: 0/5,250 County: FOND DU LAC EDEN WI 53019 Initial License: 09/09/2016 MAPLE MEADOWS ASSISTED LIVING (0016731) PRIMROSE SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 245-3093 Class: CNA 1001 PRIMROSE LANE ADVANCED AGED FOND DU LAC WI 54935-1800 LEE JOHNSON Gender - Capacity: M/F - 20 (920) 245-3093 TIFFANY MORTH 1675 E RIVERSIDE DR STE 200 Low/High rate: 2,190/6,133 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC EAGLE ID 83616 Initial License: 06/16/2017 PUBLIC FUNDING Association Approval: WiCAL MARVINS MANOR IV (0013617) MARVINS MANOR LLC Type: CBRF HCBS COMPLIANT (920) 763-3547 Class: CNA 10 PLUIM DR ADVANCED AGED WAUPUN WI 53963 BARBARA HENDRICKS Gender - Capacity: M/F - 25 (920) 324-9755 BARBARA HENDRICKS 756 EDGEWOOD DR Low/High rate: 3,250/3,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC WAUPUN WI 53963 Initial License: 01/31/2011 TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 44 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PLEASANT PARK PLACE (0017897) PLEASANT PARK PLACE LLC Type: CBRF HCBS COMPLIANT (920) 896-0036 Class: CNA 1450 N PLEASANT ST ADVANCED AGED RIPON WI 54971 ROTH WEAVER Gender - Capacity: M/F - 48 (920) 896-0036 ROTH WEAVER 101 N WACKER DR STE 616 Low/High rate: 4,000/6,000 ALCOHOL/DRUG DEPENDENT County: FOND DU LAC CHICAGO IL 60606 Initial License: 11/13/2019 CORRECTIONAL CLIENTS DEVELOPMENTALLY DISABLED IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY PRAIRIE PLACE CBRF (0014486) PRAIRIE ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (920) 748-8900 Class: CNA 745 E OSHKOSH ST ADVANCED AGED RIPON WI 54971 JEREMIAH GROTHE Gender - Capacity: M/F - 20 (920) 748-8903 DAWN WILSON 749 E OSHKOSH ST Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC RIPON WI 54971 Initial License: 01/23/2013 RESCARE UPLAND II (0016947) RESCARE RESIDENTIAL SERVICES WISCONSIN Type: CBRF HCBS COMPLIANT (502) 394-2100 Class: CNA 109 UPLAND DR DEVELOPMENTALLY DISABLED BRANDON WI 53919 NICOLE MCMILLAN Gender - Capacity: M/F - 6 (920) 346-2105 NICOLE MCMILLAN 383 WILLIAMSTOWNE STE 201 Low/High rate: 4,650/4,805 PUBLIC FUNDING County: FOND DU LAC DELAFIELD WI 53018 Initial License: 11/01/2017 ROBERT E BERRY HOUSE (410017) ADULT CARE CONSULTANTS INC Type: CBRF HCBS COMPLIANT (920) 922-8580 Class: AA 178 SIXTH ST DEVELOPMENTALLY DISABLED FOND DU LAC WI 54935 BEVERLEY GUDEX Gender - Capacity: M/F - 8 (920) 922-8580 BEVERLEY GUDEX 178 SIXTH ST Low/High rate: 2,987/3,193 EMOTIONALLY DISTURBED/MENTAL County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 11/01/1978 PUBLIC FUNDING SAGE MEADOW FOND DU LAC MC (0017584) A6 FOND DU LAC MC Type: CBRF HCBS COMPLIANT (312) 462-4462 Class: CNA 154 S PIONEER PARKWAY ADVANCED AGED FOND DU LAC WI 54935 THOMAS OSTROM Gender - Capacity: M/F - 20 (920) 921-3993 LAURA SCHWARTZ 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC CHICAGO IL 60606 Initial License: 05/30/2019 TERMINALLY ILL SERENITY VILLA V (0017704) EVELEE LLC Type: CBRF HCBS COMPLIANT (262) 689-6973 Class: CNA 280 N BAUMANN ST ADVANCED AGED CAMPBELLSPORT WI 53010 TRACY ERMER Gender - Capacity: M/F - 22 (920) 533-4300 TRACY ERMER 7860 HIGHLAND DR Low/High rate: 5,200/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC KEWASKUM WI 53040 Initial License: 07/01/2019 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TARFA TERRACE (410094) FOND DU LAC LUTHERAN HOME INC DBA TARFA Type: CBRF HCBS COMPLIANT (920) 921-9520 Class: CNA 54 W ARNDT ST ADVANCED AGED FOND DU LAC WI 54935 CLAY STOLTZ Gender - Capacity: M/F - 32 (920) 921-9520 CLAY STOLTZ 54 W ARNDT ST Low/High rate: 3,452/5,308 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 07/01/1986 Association Approval: LeadingAge Wisconsin TOUCHSTONE LIVING CENTER LLC (0011312) TOUCHSTONE LIVING CENTERS LLC Type: CBRF HCBS COMPLIANT (920) 922-7242 Class: CNA 300 WINNEBAGO ST ADVANCED AGED N FOND DU LAC WI 54937 CYNTHIA KILGAS Gender - Capacity: M/F - 26 (920) 922-7242 CYNTHIA KILGAS 300 WINNEBAGO ST Low/High rate: 4,500/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC N FOND DU LAC WI 54937 Initial License: 05/01/2006 PUBLIC FUNDING TERMINALLY ILL TOWER VIEW VILLA CORP (0009774) TOWER VIEW VILLA CORP Type: CBRF HCBS COMPLIANT (920) 872-2378 Class: CNA 401 N GRANT ST ADVANCED AGED ROSENDALE WI 54974 BARBARA SULLIVAN Gender - Capacity: M/F - 16 (920) 872-2550 BARBARA SULLIVAN N8149 CTH M Low/High rate: 3,330/4,350 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC RIPON WI 54971 Initial License: 09/12/2002 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 45 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

WOLVERTON GLEN ASSISTED LIVING (0018075) WHISPERING PINES NURSING AND REHAB LLC Type: CBRF HCBS COMPLIANT (773) 825-3336 Class: CNA 50 SUNSET AVENUE ADVANCED AGED RIPON WI 54971 HALEY HALL Gender - Capacity: M/F - 20 (920) 745-1199 HALEY HALL 50 WOLVERTON AVENUE Low/High rate: 2,725/3,290 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC RIPON WI 54971 Initial License: 05/12/2020 Association Approval: WiCAL WOODLANDS SENIOR PARK (0010166) WOODLANDS OF FOND DU LAC LLC Type: CBRF HCBS COMPLIANT (920) 922-8770 Class: CNA 77 WISCONSIN AMERICAN DR ADVANCED AGED FOND DU LAC WI 54935 SUZANNE HENDRICKSON Gender - Capacity: M/F - 30 (920) 922-8770 SUZANNE HENDRICKSON 77 WISCONSIN AMERICAN DRIVE Low/High rate: 3,850/4,225 IRREVERSIBLE DEMENTIA/ALZHEIM County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 09/17/2003 PUBLIC FUNDING TERMINALLY ILL WOODLANDS SENIOR PARK (0011204) THE WOODLANDS LLC Type: CBRF ADVANCED AGED (920) 922-8770 Class: CNA 87 WISCONSIN AMERICAN DR IRREVERSIBLE DEMENTIA/ALZHEIM FOND DU LAC WI 54935 SUE HENDRICKSON Gender - Capacity: M/F - 34 (920) 273-0335 SUZANNE HENDRICKSON 77 WISCONSIN AMERICAN DR Low/High rate: 4,070/5,400 TERMINALLY ILL County: FOND DU LAC FOND DU LAC WI 54935 Initial License: 03/07/2006 MAPLEWOOD VILLA LLC CBRF (0014330) MAPLEWOOD VILLA LLC Type: CBRF HCBS COMPLIANT (715) 336-2044 Class: CNA 9343 STATE HWY 101 ADVANCED AGED ARMSTRONG CREEK WI 54103 JOEL KOLL Gender - Capacity: M/F - 16 (715) 336-2044 JOEL KOLL 9343 STATE HWY 101 Low/High rate: 2,500/4,600 DEVELOPMENTALLY DISABLED County: FOREST ARMSTRONG CREEK WI 54103 Initial License: 01/09/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY HOME WITH A HEART (0017740) KNH LLC Type: CBRF HCBS COMPLIANT (608) 604-9942 Class: CNA 435 W WALNUT ST ADVANCED AGED MUSCODA WI 53573 KENDA MCCONKEY Gender - Capacity: M/F - 12 (608) 739-3450 TONYA CARLEY 777 S JAMES ST Low/High rate: 3,750/12,000 DEVELOPMENTALLY DISABLED County: GRANT RICHLAND CENTER WI 53581 Initial License: 07/16/2019 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING LYGHTHOUSE LLC (0008993) LYGHTHOUSE LLC Type: CBRF HCBS COMPLIANT (608) 348-4944 Class: CNA 1976 OLD LANCASTER RD ADVANCED AGED PLATTEVILLE WI 53818 ROXANNE LYGHT Gender - Capacity: M/F - 17 (608) 348-4696 ROXANNE LYGHT 1973 OLD LANCASTER RD Low/High rate: 4,500/6,300 EMOTIONALLY DISTURBED/MENTAL County: GRANT PLATTEVILLE WI 53818 Initial License: 05/01/2000 PUBLIC FUNDING TRAUMATIC BRAIN INJURY WAIVER CERTIFIED INDEPENDENT C OUR HOUSE PLATTEVILLE ASSISTED CARE (0013380) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 1735 N WATER ST ADVANCED AGED PLATTEVILLE WI 53818 LORI NARDIN Gender - Capacity: M/F - 20 (608) 348-6622 Staci Runde 4350 156th ST Low/High rate: 4,210/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: GRANT CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING PARK PLACE ASSISTED LIVING (0012395) ELDERSPAN MANAGEMENT LLC Type: CBRF HCBS COMPLIANT (608) 243-8800 Class: CNA 1015 N ELM ST ADVANCED AGED PLATTEVILLE WI 53818 DAVID GRIFFIN Gender - Capacity: M/F - 28 (608) 348-5310 ANGIE PIERCE 2445 DARWIN ROAD STE 109 Low/High rate: 5,250/5,400 PHYSICALLY DISABLED County: GRANT MADISON WI 53704 Initial License: 08/21/2008 PUBLIC FUNDING TERMINALLY ILL WAIVER CERTIFIED INDEPENDENT C Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 46 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PARK PLACE MEMORY CARE (0012396) ELDERSPAN MANAGEMENT LLC Type: CBRF HCBS COMPLIANT (608) 243-8800 Class: CNA 1155 N ELM ST ADVANCED AGED PLATTEVILLE WI 53818 DAVID GRIFFIN Gender - Capacity: M/F - 17 (608) 348-5311 ANGIE PIERCE 2445 DARWIN ROAD STE 109 Low/High rate: 6,240/6,390 IRREVERSIBLE DEMENTIA/ALZHEIM County: GRANT MADISON WI 53704 Initial License: 11/01/2008 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL WAIVER CERTIFIED INDEPENDENT C Association Approval: LeadingAge Wisconsin SIENNA CREST PLATTEVILLE (0012464) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 1480 BEARS CT ADVANCED AGED PLATTEVILLE WI 53818 SUE WHITE Gender - Capacity: M/F - 20 (608) 348-6450 SUE WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 3,900/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: GRANT OREGON WI 53575 Initial License: 09/01/2008 PUBLIC FUNDING VISTA HOUSE (0013715) UPLAND POINT CORPORATION Type: CBRF HCBS COMPLIANT (608) 341-8301 Class: CNA 111 VISTA PLACE DEVELOPMENTALLY DISABLED BOSCOBEL WI 53805 Bernard BOBER Gender - Capacity: M/F - 8 (608) 341-8301 Bernard BOBER PO Box 110 Low/High rate: 3,255/5,992 EMOTIONALLY DISTURBED/MENTAL County: GRANT MINERAL POINT WI 53565 Initial License: 06/07/2011 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY ALBANY OAKS ASSISTED LIVING (0016902) IVY LANE LLC Type: CBRF HCBS COMPLIANT (262) 914-0246 Class: CNA 750 Carolan Dr ADVANCED AGED ALBANY WI 53502 Andrew Dopuch Gender - Capacity: M/F - 15 (262) 914-0246 Andrew Dopuch 25615 91st Street Low/High rate: 3,550/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN Salem WI 53168 Initial License: 01/02/2018 PHYSICALLY DISABLED TERMINALLY ILL AZURA MEMORY CARE MONROE (0013409) AZURA MONROE LLC Type: CBRF HCBS COMPLIANT (608) 329-6340 Class: CNA 2800 6TH AVE ADVANCED AGED MONROE WI 53566 JILL KREIDER Gender - Capacity: M/F - 19 (608) 329-6340 Valerie Peralta 1233 MAYFAIR RD STE 301 Low/High rate: 5,050/6,925 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN MILWAUKEE WI 53226 Initial License: 08/15/2010 AZURA MEMORY CARE MONROE 2 (0013408) AZURA MONROE 2 LLC Type: CBRF HCBS COMPLIANT (608) 329-6340 Class: CNA 2810 6TH AVE ADVANCED AGED MONROE WI 53566 JILL KREIDER Gender - Capacity: M/F - 8 (608) 329-6340 Valerie Peralta 1233 N MAYFAIR RD STE 301 Low/High rate: 5,050/6,925 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN MILWAUKEE WI 53226 Initial License: 08/15/2010 CARING HANDS 2 INC (110338) CARING HANDS 2 INC Type: CBRF HCBS COMPLIANT (608) 558-6580 Class: CNA 605 E 4TH AVE ADVANCED AGED BRODHEAD WI 53520 STEVE VANDLEN Gender - Capacity: M/F - 10 (608) 897-2451 STEVE VANDLEN 605 E 4TH AVE Low/High rate: 2,800/3,400 EMOTIONALLY DISTURBED/MENTAL County: GREEN BRODHEAD WI 53520 Initial License: 04/30/1992 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING COLLINWOOD MEMORY CARE (0016901) DISCH ENTERPRISES LTD Type: CBRF ADVANCED AGED (608) 862-3383 Class: CNA 703 GREEN STREET EMOTIONALLY DISTURBED/MENTAL BRODHEAD WI 53520 LOUANN HARMEL Gender - Capacity: M/F - 11 (608) 897-9444 TONI ROWLEY N 5219 COUNTY ROAD E Low/High rate: 4,500/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN ALBANY WI 53502 Initial License: 01/23/2018 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WiCAL COMMUNITY LIVING HOME OPTIONS LLC (0012717) COMMUNITY LIVING HOME OPTIONS LLC Type: CBRF HCBS COMPLIANT (608) 214-5683 Class: CNA 215 3RD ST ADVANCED AGED MONROE WI 53566 ELIZABETH ANDERSON Gender - Capacity: M/F - 12 (608) 329-4991 ELIZABETH ANDERSON 215 3RD ST Low/High rate: 3,750/5,800 DEVELOPMENTALLY DISABLED County: GREEN MONROE WI 53566 Initial License: 04/06/2009 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 47 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

GRACELAND MANOR II (110515) GRACELAND MANOR OF MONROE LLC Type: CBRF HCBS COMPLIANT (608) 558-0864 Class: CNA 320 W 17TH ST ADVANCED AGED MONROE WI 53566 JODY R NEUENSCHWANDER Gender - Capacity: M/F - 14 (608) 329-7090 JODY R NEUENSCHWANDER 320 W 17TH ST Low/High rate: 3,600/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN MONROE WI 53566 Initial License: 06/30/1996 PHYSICALLY DISABLED TERMINALLY ILL MORNING SUN CARE HOME (0015373) MORNING SUN CARE HOME INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 897-6191 Class: AA N4166 COUNTY ROAD E EMOTIONALLY DISTURBED/MENTAL BRODHEAD WI 53520 JAY KENNEDY Gender - Capacity: M/F - 8 (608) 897-8211 JAY KENNEDY N4166 COUNTY ROAD E Low/High rate: 1,700/2,387 County: GREEN BRODHEAD WI 53520 Initial License: 03/12/2015 PLEASANT VIEW OROURKE DEMENTIA STABILIZATION U PLEASANT VIEW NURSING HOME Type: CBRF HCBS COMPLIANT (608) 325-2171 Class: CNA N3150 HIGHWAY 81 ADVANCED AGED MONROE WI 53566 TERRY SNOW Gender - Capacity: M/F - 6 (608) 325-2171 TERRY SNOW N3150 HIGHWAY 81 Low/High rate: 21,292/22,812 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN MONROE WI 53566 Initial License: 07/01/2021 RACHELS CHOICE (0017243) COMMUNITY LIVING HOME OPTIONS LLC Type: CBRF ADVANCED AGED (608) 329-4991 Class: CNA 316 3RD AVE DEVELOPMENTALLY DISABLED MONROE WI 53566 ELIZABETH ANDERSON ADAM Gender - Capacity: M/F - 8 (608) 329-4911 ELIZABETH ANDERSON 215 3RD ST Low/High rate: 3,750/5,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN MONROE WI 53566 Initial License: 10/17/2018 PHYSICALLY DISABLED TERMINALLY ILL BARRETT HOUSE OF MARKESAN (0016788) BRIDGET VREDEVELD Type: CBRF ADVANCED AGED (920) 296-8193 Class: CNA 185 E JOHN STREET DEVELOPMENTALLY DISABLED MARKESAN WI 53946 BRIDGET VREDEVELD Gender - Capacity: M/F - 15 (920) 398-2989 BRIDGET VREDEVELD 185 W JOHN STREET Low/High rate: 3,600/4,500 EMOTIONALLY DISTURBED/MENTAL County: GREEN LAKE MARKESAN WI 53946 Initial License: 09/01/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL BROWN WILCOX RETIREMENT HOME (410143) BROWN WILCOX TRUSTEES CO INC Type: CBRF HCBS COMPLIANT (920) 361-2605 Class: CNA 347 E HURON ST ADVANCED AGED BERLIN WI 54923 PETER MAUEL Gender - Capacity: M/F - 20 (920) 361-2552 NICOLE TER BEEST PO BOX 150 Low/High rate: 2,865/3,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN LAKE BERLIN WI 54923 Initial License: 02/01/1980 PUBLIC FUNDING KINDREDHEARTS GREEN LAKE (0011582) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 256-0488 Class: CNA 860 SUNNYSIDE RD ADVANCED AGED GREEN LAKE WI 54941 DOUGLAS HENNIG Gender - Capacity: M/F - 14 (920) 294-1000 AMBER GRUNEWALD 850 SUNNYSIDE RD Low/High rate: 3,456/5,169 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN LAKE GREEN LAKE WI 54941 Initial License: 09/01/2006 PUBLIC FUNDING MARTHAS INC (410197) MARTHAS INC Type: CBRF HCBS COMPLIANT (920) 295-6762 Class: CNA 404 W WATER ST ADVANCED AGED PRINCETON WI 54968 MARIETTA BENTLEY Gender - Capacity: M/F - 15 (920) 295-4222 MARIETTA BENTLEY 404 W WATER ST Low/High rate: 1,685/3,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN LAKE PRINCETON WI 54968 Initial License: 10/13/1989 PHYSICALLY DISABLED PUBLIC FUNDING MOUND STREET (0016057) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 284 MOUND ST ADVANCED AGED BERLIN WI 54923 BARB SALEMI Gender - Capacity: M/F - 5 (920) 361-1395 CODY BOELKE 424 WASHINGTON AVE Low/High rate: 5,056/5,322 DEVELOPMENTALLY DISABLED County: GREEN LAKE OSHKOSH WI 54901 Initial License: 02/15/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY PATRIOT PLACE CBRF (0016752) NBA HOLDINGS LLC Type: CBRF HCBS COMPLIANT (920) 293-1015 Class: CNA 609 BROADWAY STREET ADVANCED AGED BERLIN WI 54923 KELSEA PAEZ Gender - Capacity: M/F - 20 (920) 361-3007 KELSEA PAEZ 609 BROADWAY STREET Low/High rate: 2,900/4,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: GREEN LAKE BERLIN WI 54923 Initial License: 03/12/2018 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 48 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CORNERSTONE FOUNDATION KENZIE STREET CBRF (00 LUCKY STAR 3 CORP Type: CBRF HCBS COMPLIANT (608) 935-1649 Class: CNA 201 N KENZIE ST DEVELOPMENTALLY DISABLED BARNEVELD WI 53507 RICK STARR Gender - Capacity: M/F - 8 (608) 924-2611 JEAN ONEILL PO BOX 150 Low/High rate: 3,200/3,800 EMOTIONALLY DISTURBED/MENTAL County: IOWA DODGEVILLE WI 53533 Initial License: 04/21/2010 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CRESTRIDGE ASSISTED LIVING OF DODGEVILLE LLC (11 ELDERSPAN MANAGEMENT LLC Type: CBRF HCBS COMPLIANT (608) 243-8800 Class: CNA 219 EAST GRACE ST ADVANCED AGED DODGEVILLE WI 53533 DAVID GRIFFIN Gender - Capacity: M/F - 40 (608) 935-0211 BRENDA M WELSH 2445 DARWIN ROAD STE 109 Low/High rate: 5,070/6,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: IOWA MADISON WI 53704 Initial License: 07/20/1998 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL WAIVER CERTIFIED INDEPENDENT C Association Approval: LeadingAge Wisconsin SIENNA CREST DODGEVILLE (0009500) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 404 EAST MADISON ST ADVANCED AGED DODGEVILLE WI 53533 SUSAN WHITE Gender - Capacity: M/F - 15 (608) 935-9430 SUSAN WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 3,780/5,280 IRREVERSIBLE DEMENTIA/ALZHEIM County: IOWA OREGON WI 53575 Initial License: 10/29/2001 PUBLIC FUNDING SIENNA CREST MINERAL POINT (0008694) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 210 COPPER ST ADVANCED AGED MINERAL POINT WI 53565 SUE WHITE Gender - Capacity: M/F - 20 (608) 987-4565 SUE WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 4,700/6,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: IOWA OREGON WI 53575 Initial License: 08/01/1999 PUBLIC FUNDING SPRING HOUSE (110435) UPLAND POINT CORPORATION Type: CBRF HCBS COMPLIANT (608) 341-8301 Class: CNA 404 PINE ST DEVELOPMENTALLY DISABLED MINERAL POINT WI 53565 Bernard BOBER Gender - Capacity: M/F - 8 (608) 341-8301 Sam BOBER PO Box 110 Low/High rate: 3,194/6,240 EMOTIONALLY DISTURBED/MENTAL County: IOWA MINERAL POINT WI 53565 Initial License: 09/14/1994 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY SUNNYSIDE EAST (0012968) UPLAND POINT CORPORATION Type: CBRF HCBS COMPLIANT (608) 341-8301 Class: CNA 207 W PARRY ST EMOTIONALLY DISTURBED/MENTAL DODGEVILLE WI 53533 Bernie BOBER Gender - Capacity: M/F - 8 (608) 341-8301 Bernie BOBER PO Box 110 Low/High rate: 3,650/6,083 PHYSICALLY DISABLED County: IOWA MINERAL POINT WI 53565 Initial License: 11/01/2009 PUBLIC FUNDING TRAUMATIC BRAIN INJURY SUNNYSIDE WEST (0012225) UPLAND POINT CORPORATION Type: CBRF HCBS COMPLIANT (608) 341-8301 Class: CNA 209 W PARRY ST DEVELOPMENTALLY DISABLED DODGEVILLE WI 53533 Bernard BOBER Gender - Capacity: M/F - 8 (608) 341-8301 Bernard BOBER PO Box 110 Low/High rate: 4,217/6,938 PHYSICALLY DISABLED County: IOWA MINERAL POINT WI 53565 Initial License: 02/04/2008 TRAUMATIC BRAIN INJURY MAPLE LEAF GROUP HOME (610279) HIGHLINE CORPORATION Type: CBRF HCBS COMPLIANT (715) 561-4515 Class: AA 5630 W US HWY 2 DEVELOPMENTALLY DISABLED HURLEY WI 54534 DONNA REINERIO Gender - Capacity: M/F - 5 (715) 561-4515 DONNA REINERIO PO BOX 218 Low/High rate: 2,795/2,795 EMOTIONALLY DISTURBED/MENTAL County: IRON HURLEY WI 54534 Initial License: 02/28/1980 PUBLIC FUNDING COUNTRY TERRACE BLACK RIVER FALLS (0010113) COUNTRY TERRACE OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 525 E SECOND ST ADVANCED AGED BLACK RIVER FALLS WI 54615 JASON LINDEMANN Gender - Capacity: M/F - 17 (715) 284-2060 TINA PICK PO BOX 3006 Low/High rate: 2,600/4,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: JACKSON OSHKOSH WI 54903-3006 Initial License: 01/21/2003 PHYSICALLY DISABLED TERMINALLY ILL COUNTRY TERRACE BLACK RIVER FALLS II (0016076) COUNTRY TERRACE Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 642 E 3RD ST ADVANCED AGED BLACK RIVER FALLS WI 54615 JASON LINDEMANN Gender - Capacity: M/F - 25 (715) 284-2060 TINA PICK PO BOX 3006 Low/High rate: 3,900/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: JACKSON OSHKOSH WI 54903 Initial License: 03/17/2016 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 49 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MEADOWBROOK AT BLACK RIVER FALLS (0017941) BRF NURSING AND REHAB LLC Type: CBRF HCBS COMPLIANT (847) 942-7575 Class: CNA 109 NORTH 14TH STREET ADVANCED AGED BLACK RIVER FALLS WI 54615 JOHN STARKEY Gender - Capacity: M/F - 32 (715) 284-4396 GAIL JACOBSON 109 NORTH 14TH STREET Low/High rate: 3,500/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: JACKSON BLACK RIVER FALLS WI 54615 Initial License: 12/01/2019 RJS CARE HOME LLC (510349) RJS CARE HOME LLC Type: CBRF HCBS COMPLIANT (715) 896-0510 Class: AA N7525 COUNTY RD A ADVANCED AGED HIXTON WI 54635 ROY & JILL LABAR Gender - Capacity: M/F - 9 (715) 284-0094 JILL LABAR N7525 COUNTY RD A Low/High rate: 1,550/3,032 ALCOHOL/DRUG DEPENDENT County: JACKSON HIXTON WI 54635 Initial License: 11/04/1996 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING WAZEE HOUSE (510066) LUTHERAN SOC SERV OF WI & UPPER MI INC Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 834-2046 Class: AA N5488 HWY 54 W CORRECTIONAL CLIENTS BLACK RIVER FALLS WI 54615 PAULA UPP Gender - Capacity: M - 12 (715) 284-4987 LYNDA OLSON 3003 N RICHMOND Low/High rate: 2,879/2,879 County: JACKSON APPLETON WI 54911 Initial License: 02/01/1980 Autumn Winds llc (0016509) AUTUMN WINDS LLC Type: CBRF ADVANCED AGED (608) 423-9300 Class: CNA N3767 Airport RD DEVELOPMENTALLY DISABLED CAMBRIDGE WI 53523 LYNN COOPER Gender - Capacity: M/F - 10 (608) 423-9300 LYNN COOPER N3767 Airport Rd. Low/High rate: 3,800/4,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON Cambridge WI 53523 Initial License: 02/21/2017 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY BIRCH TERRACE CBRF (310314) ABILITIES INC Type: CBRF HCBS COMPLIANT (920) 563-8554 Class: CNA 1109 CASWELL ST ADVANCED AGED FORT ATKINSON WI 53538 CHRISTINE KLITZKIE Gender - Capacity: M/F - 8 (920) 563-8554 Christine Klitzkie PO BOX 84 Low/High rate: 4,021/6,077 DEVELOPMENTALLY DISABLED County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 12/15/1994 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING BLACK HAWK SENIOR RESIDENCE (0014288) BLACK HAWK RESIDENTIAL OPERATIONS LLC Type: CBRF HCBS COMPLIANT (920) 563-1480 Class: CNA 1 MILWAUKEE AVE WEST ADVANCED AGED FORT ATKINSON WI 53538 P ANDREW LOGAN Gender - Capacity: M/F - 38 (920) 563-1480 PAUL ANDREW LOGAN 1 MILWAUKEE AVE WEST Low/High rate: 3,900/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 10/03/2012 CEDAR HILL (310332) ABILITIES INC Type: CBRF HCBS COMPLIANT (920) 563-8554 Class: CNA N1366 HWY 12 DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 CHRISTINE KLITZKIE Gender - Capacity: M/F - 6 (920) 563-4869 CHRISTINE KLITZKIE PO BOX 84 Low/High rate: 4,513/5,416 EMOTIONALLY DISTURBED/MENTAL County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 02/15/1994 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CRABAPPLE COURT CBRF (0014290) ABILITIES INC Type: CBRF HCBS COMPLIANT (920) 563-8554 Class: AA 1315 S MAIN ST DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 CHRISTINE KLITZKIE Gender - Capacity: M/F - 8 (920) 563-8554 Christine KLITZKIE PO BOX 84 Low/High rate: 3,186/4,307 EMOTIONALLY DISTURBED/MENTAL County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 06/01/2013 PUBLIC FUNDING DOHERTY HOME (0011631) PRADER WILLI HOMES OF OCONOMOWOC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AA N7855 LITTLE COFFEE RD DEVELOPMENTALLY DISABLED WATERTOWN WI 53094 Vicki Raml-Glider Gender - Capacity: M/F - 8 (262) 468-0366 Sarah Goralski PO BOX 278 Low/High rate: 6,776/6,776 County: JEFFERSON DOUSMAN WI 53118 Initial License: 10/02/2006 EAGLE VIEW MANOR (0014897) CARESHARE ASSISTED LIVING, INC Type: CBRF HCBS COMPLIANT (414) 588-4465 Class: CNA 881 COLLINS ROAD ADVANCED AGED JEFFERSON WI 53549 MARK ROEGNER Gender - Capacity: M/F - 16 (920) 674-3468 Katrina Moore 5726 DEBBIE LN Low/High rate: 2,950/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON WEST BEND WI 53095 Initial License: 02/04/2014 PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 50 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

FALCONS NEST CBRF (0012983) ABILITIES INC Type: CBRF HCBS COMPLIANT (920) 563-8554 Class: CNA 160 W BLACKHAWK DR DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 CHRISTINE KLITZKIE Gender - Capacity: M/F - 8 (920) 563-8554 CHRISTINE KLITZKIE PO BOX 84 Low/High rate: 3,194/5,240 PHYSICALLY DISABLED County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 11/17/2009 PUBLIC FUNDING GOLDEN EAGLE CBRF (0012778) ABILITIES INC Type: CBRF HCBS COMPLIANT (920) 563-8554 Class: CNA 216 W BLACKHAWK DR ADVANCED AGED FORT ATKINSON WI 53538 CHRISTINE KLITZKIE Gender - Capacity: M/F - 5 (920) 397-7292 CHRISTINE KLITZKIE PO BOX 84 Low/High rate: 5,184/6,446 DEVELOPMENTALLY DISABLED County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 06/15/2009 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY HIL APPLE HOUSE (0012615) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 1621 PREMIER PL DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 Ashley Williams Gender - Capacity: M/F - 8 (920) 568-0925 SARA STACHEL WAGNER 1249 RUSSETT COURT Low/High rate: 4,825/4,825 PHYSICALLY DISABLED County: JEFFERSON GREEN BAY WI 54313 Initial License: 01/30/2009 PUBLIC FUNDING TRAUMATIC BRAIN INJURY HIL COMMONWEALTH HOME (0011559) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 1501 COMMONWEALTH DR DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 Ashley Williams Gender - Capacity: M/F - 7 (920) 563-3245 Melissa Goodearle 1249 RUSSETT COURT Low/High rate: 5,661/5,661 PHYSICALLY DISABLED County: JEFFERSON GREEN BAY WI 54313 Initial License: 08/09/2006 PUBLIC FUNDING TRAUMATIC BRAIN INJURY HIL LINDEN CORNER (0009792) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 325 W BLACKHAWK DR DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 Ashley Williams Gender - Capacity: M/F - 7 (920) 568-0925 SARA STACHEL WAGNER 1249 RUSSETT COURT Low/High rate: 5,757/5,757 PUBLIC FUNDING County: JEFFERSON GREEN BAY WI 54313 Initial License: 01/01/2002 HIL SANDSTONE (0009793) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 1533 S MAIN ST DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 Ashley Williams Gender - Capacity: M/F - 7 (920) 568-0925 Sara Stachel-Wagner 1249 RUSSETT COURT Low/High rate: 5,097/5,097 PUBLIC FUNDING County: JEFFERSON GREEN BAY WI 54313 Initial License: 01/01/2002 HIL WILLOW COURT (0009795) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 575 BLACKHAWK DR DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 Ashley Williams Gender - Capacity: M/F - 7 (920) 568-0925 Sara Stachel Wager 1249 RUSSETT COURT Low/High rate: 5,411/5,411 PUBLIC FUNDING County: JEFFERSON GREEN Bay WI 54313 Initial License: 01/01/2002 TRAUMATIC BRAIN INJURY JEFFERSON MEMORY CARE LLC (0015378) MEMORY CARE PARTNERS LLC Type: CBRF HCBS COMPLIANT (715) 523-0030 Class: CNA 414 COUNTY HWY Y ADVANCED AGED JEFFERSON WI 53549 ANA HINES Gender - Capacity: M/F - 77 (920) 541-3520 Tareva Avitt 4407 124th STREET Low/High rate: 4,800/10,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON CHIPPEWA FALLS WI 54729 Initial License: 11/12/2014 LILAC SPRINGS ASSISTED LIVING (0015529) LILAC SPRINGS LLC Type: CBRF HCBS COMPLIANT (262) 923-0469 Class: CNA 403 ONEIL STREET ADVANCED AGED LAKE MILLS WI 53551 SHARI WAGGONER Gender - Capacity: M/F - 24 (920) 945-0040 Brittany Porep 3955 HAWKS RIDGE DRIVE Low/High rate: 4,050/5,450 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON HUBERTUS WI 53033 Initial License: 04/27/2015 TERMINALLY ILL Association Approval: WALA LONDON LODGE I (310455) LONDON LODGE INC Type: CBRF HCBS COMPLIANT (608) 235-1558 Class: CNA W9095 LONDON RD ADVANCED AGED CAMBRIDGE WI 53523 MARGARET PENNEWELL Gender - Capacity: M/F - 8 (920) 648-3171 MARGARET PENNEWELL W9095 LONDON RD Low/High rate: 2,619/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON CAMBRIDGE WI 53523 Initial License: 01/09/1996 PHYSICALLY DISABLED PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 51 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LONDON LODGE II (310717) LONDON LODGE INC Type: CBRF HCBS COMPLIANT (920) 648-3171 Class: CNA W9097 LONDON RD ADVANCED AGED CAMBRIDGE WI 53523 MARGARET PENNEWELL Gender - Capacity: M/F - 8 (920) 648-2309 MARGARET PENNEWELL W9095 LONDON RD Low/High rate: 3,706/5,008 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON CAMBRIDGE WI 53523 Initial License: 10/16/1998 PHYSICALLY DISABLED PUBLIC FUNDING LUEDER HOUSE (310460) JEFFERSON COUNTY HUMAN SERVICES DEPT Type: CBRF EMOTIONALLY DISTURBED/MENTAL 1473 ANNEX RD (920) 674-3105 Class: AA JEFFERSON WI 53549 TERRI JURCZYK Gender - Capacity: M/F - 8 (920) 674-8114 TERRI JURCZYK 1473 ANNEX RD Low/High rate: 5,799/5,779 County: JEFFERSON JEFFERSON WI 53549 Initial License: 07/31/1995 MAPLE RUN CBRF (0012086) ABILITIES INC Type: CBRF HCBS COMPLIANT (920) 563-8554 Class: CS N2489 WENHAM RD DEVELOPMENTALLY DISABLED FORT ATKINSON WI 53538 CHRISTINE KLITZKIE Gender - Capacity: M - 6 (920) 568-0413 CHRISTINE KLITZKIE PO BOX 84 Low/High rate: 4,641/6,852 EMOTIONALLY DISTURBED/MENTAL County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 10/11/2007 PHYSICALLY DISABLED PUBLIC FUNDING MARGARET RUTH HOME (310407) PRADER WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-4848 Class: AA N8007 LAKEVIEW DR DEVELOPMENTALLY DISABLED TOWN OF IXONIA WI 53036 Vicki Raml-Glider Gender - Capacity: M/F - 8 (262) 569-5533 Kristina Lumby PO BOX 278 Low/High rate: 7,463/7,463 County: JEFFERSON DOUSMAN WI 53118 Initial License: 02/01/1990 MY PLACE OF WATERTOWN (0016727) NORMIC ENTERPRISE INC Type: CBRF DEVELOPMENTALLY DISABLED (414) 962-5999 Class: AA N8761 OVERLAND DRIVE EMOTIONALLY DISTURBED/MENTAL WATERTOWN WI 53094 CAROL WHITNEY Gender - Capacity: M - 6 (414) 962-5999 COLIN WHITNEY N248 COUNTY ROAD P Low/High rate: 6,000/9,000 PHYSICALLY DISABLED County: JEFFERSON OCONOMOWOC WI 53066 Initial License: 01/04/2018 TRAUMATIC BRAIN INJURY REENA SENIOR LIVING (0017764) ICONICARE FORT ATKINSON LLC Type: CBRF HCBS COMPLIANT (608) 664-3500 Class: CNA 737 REENA AVE ADVANCED AGED FORT ATKINSON WI 53538 JENNIFER BRATZ Gender - Capacity: M/F - 20 (920) 542-1521 JENNIFER BRATZ 737 REENA AVE Low/High rate: 6,100/7,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 12/04/2019 PUBLIC FUNDING Association Approval: WiCAL REM WISCONSIN II STACY LANE (0010048) REM WISCONSIN II INC Type: CBRF HCBS COMPLIANT (608) 276-1192 Class: CNA 1403 STACY LN ADVANCED AGED FORT ATKINSON WI 53538 LORI WRIGHT Gender - Capacity: M/F - 6 (815) 871-1075 Christina Corey 4033 123rd ST, STE A Low/High rate: 6,338/6,338 DEVELOPMENTALLY DISABLED County: JEFFERSON CHIPPEWA FALLS WI 54729 Initial License: 05/28/2003 PHYSICALLY DISABLED PUBLIC FUNDING RESCARE 141 MICHELLE (0016945) RESCARE RESIDENTIAL SERVICES WISCONSIN Type: CBRF HCBS COMPLIANT (502) 394-2100 Class: CNA 141 MICHELLE DR DEVELOPMENTALLY DISABLED JOHNSON CREEK WI 53038 Nicole McMillan Gender - Capacity: M/F - 6 (920) 699-3117 Nicole McMillan 383 Williamstowne Low/High rate: 4,465/4,873 County: JEFFERSON Delafield WI 53018 Initial License: 11/01/2017 ROLLING MEADOWS (0013071) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: AA N464 POEPPEL RD ALCOHOL/DRUG DEPENDENT FORT ATKINSON WI 53538 CHRISTOPHER COHEN Gender - Capacity: M/F - 7 (920) 563-9075 Dennis Patterson 209 S TAFT ST Low/High rate: 4,563/9,125 DEVELOPMENTALLY DISABLED County: JEFFERSON WHITEWATER WI 53190 Initial License: 01/01/2010 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY SHADY ACRES CBRF (0012558) ABILITIES INC Type: CBRF HCBS COMPLIANT (920) 563-8554 Class: AS N5015 HWY Y DEVELOPMENTALLY DISABLED JEFFERSON WI 53549 CHRISTINE KLITZKIE Gender - Capacity: M/F - 8 (920) 674-5015 CHRISTINE KLITZKIE PO BOX 84 Low/High rate: 4,732/7,625 EMOTIONALLY DISTURBED/MENTAL County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 11/10/2008 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 52 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SIENNA CREST FORT ATKINSON (310733) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 1531 COMMONWEALTH DR ADVANCED AGED FORT ATKINSON WI 53538 SUE WHITE Gender - Capacity: M/F - 20 (920) 568-1840 SUE WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 5,000/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON OREGON WI 53575 Initial License: 01/01/1999 PUBLIC FUNDING ST COLETTA OF WI LUCHENBACH (0012785) ST COLETTA OF WISCONSIN Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 648 E LUCHENBACH LN ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 5 (920) 674-4361 Karissa Holpfer N4637 CTY HWY Y Low/High rate: 5,978/6,977 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 05/15/2009 PHYSICALLY DISABLED PUBLIC FUNDING ST COLETTA OF WI DOWER CBRF (0013042) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 528 S KRANZ AVE ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 8 (920) 675-1616 Karissa Holpfer N4637 CTY HWY Y Low/High rate: 4,350/4,495 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 12/11/2009 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING ST COLETTA OF WI JACOBA (0012782) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 640 E THEODORE ST ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 5 (920) 674-2715 Karissa Holpfer N4637 CTY HWY Y Low/High rate: 4,140/6,823 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 05/04/2009 PHYSICALLY DISABLED PUBLIC FUNDING ST COLETTA OF WI LOURDES (310538) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 140 S KRANZ AVE ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 8 (920) 674-6399 Lori Vogel N4637 CTY HWY Y Low/High rate: 4,050/4,980 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 09/01/1985 PHYSICALLY DISABLED PUBLIC FUNDING ST COLETTA OF WI PADUA HEIGHTS (0009098) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 724 E RACINE ST ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 10 (920) 675-1610 Karissa Holpfer N4637 CTY HWY Y Low/High rate: 4,291/4,291 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 07/10/2000 PUBLIC FUNDING ST COLETTA OF WI SAN DAMIANO (310540) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 128 S KRANZ AVE ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 8 (920) 674-6485 Lori Vogel N4637 CTY HWY Y Low/High rate: 3,895/4,980 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 06/02/1985 PHYSICALLY DISABLED PUBLIC FUNDING ST COLETTA OF WI ST AGNES (310542) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: AS 900 E RACINE ST DEVELOPMENTALLY DISABLED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: F - 8 (920) 674-8230 Lori Vogel N4637 CTY HWY Y Low/High rate: 2,700/3,300 PUBLIC FUNDING County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 08/31/1993 ST COLETTA OF WI ST ISIDORE (310548) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 124 ORCHARD VIEW COURT ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M - 10 (920) 675-1603 Karissa Holpfer N4637 CTY HWY Y Low/High rate: 1,739/4,605 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 06/01/1987 PHYSICALLY DISABLED PUBLIC FUNDING ST COLETTA OF WI ST JOHN THE BAPTIST (310549) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: AS W5078 HWY 18 DEVELOPMENTALLY DISABLED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M - 8 (920) 674-8356 Karissa Holpfer N4637 CTY HWY Y Low/High rate: 3,580/4,620 PUBLIC FUNDING County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 05/11/1992

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 53 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ST COLETTA OF WI ST MARTHA (310546) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA W5092 HWY 18 ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 8 (920) 674-8268 Lori Vogel N4637 CTY HWY Y Low/High rate: 3,636/3,636 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 09/01/1980 PHYSICALLY DISABLED PUBLIC FUNDING ST COLETTA OF WI ST MICHAEL (310551) ST COLETTA OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 822 E RACINE ST ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 8 (920) 674-6860 Lori Vogel N4637 CTY HWY Y Low/High rate: 4,236/4,980 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 10/01/1985 PHYSICALLY DISABLED PUBLIC FUNDING ST COLETTA OF WI TAU (0012786) ST COLETTA OF WISCONSIN Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 621 E SPRING ST ADVANCED AGED JEFFERSON WI 53549 TED BEHNCKE Gender - Capacity: M/F - 5 (920) 674-2849 Lori Vogel N4637 CTY HWY Y Low/High rate: 5,845/7,638 DEVELOPMENTALLY DISABLED County: JEFFERSON JEFFERSON WI 53549-9720 Initial License: 05/12/2009 PHYSICALLY DISABLED PUBLIC FUNDING STEPPING STONE CBRF (0012335) ABILITIES INC Type: CBRF HCBS COMPLIANT (920) 563-8554 Class: AA 318 N MAIN ST ALCOHOL/DRUG DEPENDENT FORT ATKINSON WI 53538 CHRISTINE KLITZKIE Gender - Capacity: M/F - 8 (920) 563-8554 Christine Klitzkie PO BOX 84 Low/High rate: 4,021/4,437 DEVELOPMENTALLY DISABLED County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 05/15/2008 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING SUNSET RIDGE ASSISTED LIVING (0014539) SUNSTONE LLC Type: CBRF HCBS COMPLIANT (262) 412-4002 Class: CNA 1275 REMMEL DRIVE ADVANCED AGED JOHNSON CREEK WI 53038 ROBERT TURNER Gender - Capacity: M/F - 24 (920) 699-1275 ROBERT TURNER W 5057 Farm Village Lane Low/High rate: 4,100/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON Elkhorn WI 53121 Initial License: 05/16/2013 PUBLIC FUNDING TERMINALLY ILL SUNSET RIDGE JEFFERSON (0016540) PTB PROPERTIES Type: CBRF ADVANCED AGED (262) 945-7893 Class: CNA 826 REINEL STREET IRREVERSIBLE DEMENTIA/ALZHEIM JEFFERSON WI 53549 ROBERT K TURNER Gender - Capacity: M/F - 26 (262) 412-4002 ROBERT TURNER W5057 FARM VILLAGE LANE Low/High rate: 4,200/6,100 PUBLIC FUNDING County: JEFFERSON ELKHORN WI 53121 Initial License: 03/27/2017 Association Approval: WALA SUNSET RIDGE MEMORY CARE (0015292) SUNSTONE ASSISTED LIVING Type: CBRF HCBS COMPLIANT (262) 412-4002 Class: CNA 816 E REINEL ST ADVANCED AGED JEFFERSON WI 53549 ROBERT TURNER Gender - Capacity: M/F - 25 (920) 541-3536 ROBERT TURNER W5057 Farm Village Lane Low/High rate: 4,400/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON Elkhorn WI 53121 Initial License: 11/01/2014 SYLVAN CROSSINGS OF JEFFERSON (310666) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 279 N JACKSON AVE ADVANCED AGED JEFFERSON WI 53549 DANIEL FLEMING Gender - Capacity: M/F - 20 (920) 674-0698 DAWN KOCH 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 3,800/5,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON MADISON WI 53711 Initial License: 11/11/1997 PHYSICALLY DISABLED PUBLIC FUNDING SYLVAN CROSSINGS OF JEFFERSON (310666) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 279 N JACKSON AVE ADVANCED AGED JEFFERSON WI 53549 DANIEL FLEMING Gender - Capacity: M/F - 20 (920) 674-0698 DAWN KOCH 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 3,800/5,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON MADISON WI 53711 Initial License: 11/11/1997 PHYSICALLY DISABLED PUBLIC FUNDING VIEW AT JOHNSON CREEK (THE) (0018030) HERITAGE PROPERTIES II INC Type: CBRF ADVANCED AGED (262) 894-6828 Class: CNA 1 HARTWIG DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM JOHNSON CREEK WI 53038 DANA QUINLIN Gender - Capacity: M/F - 64 (920) 309-8480 CHRISTINE DENTON 13660 WEST CAPITOL DRIVE STE A Low/High rate: County: JEFFERSON BROOKFIELD WI 53005 Initial License: 04/24/2020

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 54 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

WELLINGTON MEADOWS (0012024) WELLINGTON HOMES OF WI LLC Type: CBRF HCBS COMPLIANT (703) 868-0503 Class: CNA 525 MEMORIAL DR ADVANCED AGED FORT ATKINSON WI 53538 Kong Chee Thao Gender - Capacity: M/F - 28 (715) 212-7937 Kong Chee Thao 525 MEMORIAL DRIVE Low/High rate: 3,156/4,156 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 09/01/2007 PUBLIC FUNDING WELLINGTON MEADOWS (0012024) WELLINGTON HOMES OF WI LLC Type: CBRF HCBS COMPLIANT (703) 868-0503 Class: CNA 525 MEMORIAL DR ADVANCED AGED FORT ATKINSON WI 53538 Kong Chee Thao Gender - Capacity: M/F - 28 (715) 212-7937 Kong Chee Thao 525 MEMORIAL DRIVE Low/High rate: 3,156/4,156 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 09/01/2007 PUBLIC FUNDING WELLINGTON MEADOWS (0012024) WELLINGTON HOMES OF WI LLC Type: CBRF HCBS COMPLIANT (703) 868-0503 Class: CNA 525 MEMORIAL DR ADVANCED AGED FORT ATKINSON WI 53538 Kong Chee Thao Gender - Capacity: M/F - 28 (715) 212-7937 Kong Chee Thao 525 MEMORIAL DRIVE Low/High rate: 3,156/4,156 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 09/01/2007 PUBLIC FUNDING WELLINGTON PLACE OF FORT ATKINSON (0012025) WELLINGTON HOMES OF WI LLC Type: CBRF HCBS COMPLIANT (703) 868-0503 Class: CNA 200 S WATER ST WEST ADVANCED AGED FORT ATKINSON WI 53538 JENNIFER WELTZIN Gender - Capacity: M/F - 20 (715) 212-7937 Kong Chee Thao 200 S WATER ST WEST Low/High rate: 3,200/3,982 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 09/07/2007 WELLINGTON PLACE OF FORT ATKINSON (0012025) WELLINGTON HOMES OF WI LLC Type: CBRF HCBS COMPLIANT (703) 868-0503 Class: CNA 200 S WATER ST WEST ADVANCED AGED FORT ATKINSON WI 53538 JENNIFER WELTZIN Gender - Capacity: M/F - 20 (715) 212-7937 Kong Chee Thao 200 S WATER ST WEST Low/High rate: 3,200/3,982 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 09/07/2007 WELLINGTON PLACE OF FORT ATKINSON (0012025) WELLINGTON HOMES OF WI LLC Type: CBRF HCBS COMPLIANT (703) 868-0503 Class: CNA 200 S WATER ST WEST ADVANCED AGED FORT ATKINSON WI 53538 JENNIFER WELTZIN Gender - Capacity: M/F - 20 (715) 212-7937 Kong Chee Thao 200 S WATER ST WEST Low/High rate: 3,200/3,982 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 09/07/2007 WELLINGTON PLACE OF FORT ATKINSON (0012025) WELLINGTON HOMES OF WI LLC Type: CBRF HCBS COMPLIANT (703) 868-0503 Class: CNA 200 S WATER ST WEST ADVANCED AGED FORT ATKINSON WI 53538 JENNIFER WELTZIN Gender - Capacity: M/F - 20 (715) 212-7937 Kong Chee Thao 200 S WATER ST WEST Low/High rate: 3,200/3,982 IRREVERSIBLE DEMENTIA/ALZHEIM County: JEFFERSON FORT ATKINSON WI 53538 Initial License: 09/07/2007 BLUFF SUITES (0017459) CASTLE ROCK CARE LLC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 548-5769 Class: CS 707 SOUTH BLUFF STREET CORRECTIONAL CLIENTS NECEDAH WI 54646 SEAN SANFORD Gender - Capacity: M/F - 8 (608) 548-5769 KATERRI SANFORD N6912 16TH AVE Low/High rate: 3,000/8,000 DEVELOPMENTALLY DISABLED County: JUNEAU NEW LISBON WI 53950 Initial License: 03/22/2019 EMOTIONALLY DISTURBED/MENTAL TERMINALLY ILL TRAUMATIC BRAIN INJURY COTTAGE CARE CENTER (0010835) DARLENE J SEEVER Type: CBRF HCBS COMPLIANT (608) 548-3208 Class: CNA 204 HALL STREET ADVANCED AGED MAUSTON WI 53948 DARLENE J SEEVER Gender - Capacity: M/F - 12 (608) 847-7470 DARLENE J SEEVER 204 HALL STREET Low/High rate: 3,195/6,000 DEVELOPMENTALLY DISABLED County: JUNEAU MAUSTON WI 53948 Initial License: 02/02/2005 IRREVERSIBLE DEMENTIA/ALZHEIM TERMINALLY ILL COTTAGE CARE CIRCLE (0013060) DARLENE SEEVER Type: CBRF HCBS COMPLIANT (608) 548-3208 Class: CNA 320 ATTEWELL STREET ADVANCED AGED MAUSTON WI 53948 DARLENE SEEVER Gender - Capacity: M/F - 16 (608) 847-6248 DARLENE SEEVER 320 ATTEWELL STREET Low/High rate: 3,195/3,195 DEVELOPMENTALLY DISABLED County: JUNEAU MAUSTON WI 53948 Initial License: 12/02/2009 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL CREST VIEW GREAT LAKES (0009594) MILE BLUFF MEDICAL CENTER INC Type: CBRF ADVANCED AGED (608) 562-3667 Class: CNA 612 VIEW ST IRREVERSIBLE DEMENTIA/ALZHEIM NEW LISBON WI 53950 JENNIFER BRANDAU Gender - Capacity: M/F - 12 (608) 562-3667 JENNIFER BRANDAU 612 VIEW ST Low/High rate: 2,585/5,921 PUBLIC FUNDING County: JUNEAU NEW LISBON WI 53950 Initial License: 04/18/2002

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 55 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

EVERGREEN MANOR INC (0010512) JIM & LARENDA ROSIN Type: CBRF HCBS COMPLIANT (920) 229-3664 Class: AA W5205 BUCKEYE DR DEVELOPMENTALLY DISABLED NECEDAH WI 54646 LARENDA ROSIN Gender - Capacity: M/F - 15 (608) 565-2522 JIM ROSIN PO BOX 900 Low/High rate: 2,283/4,500 EMOTIONALLY DISTURBED/MENTAL County: JUNEAU WAUTOMA WI 54982 Initial License: 04/08/2004 MONROE MANOR (0017989) CASTLE ROCK CARE LLC Type: CBRF HCBS COMPLIANT (608) 548-5769 Class: AA 302 S MONROE STREET ALCOHOL/DRUG DEPENDENT NEW LISBON WI 53950 SEAN SANFORD Gender - Capacity: M - 8 (608) 562-3085 KATERRI SANFORD N6912 16TH AVENUE Low/High rate: 3,000/8,000 CORRECTIONAL CLIENTS County: JUNEAU NEW LISBON WI 53950 Initial License: 03/25/2020 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL TRAUMATIC BRAIN INJURY OAK RUN CBRF (0014576) DEER PATH INTEGRATED LIVING INC Type: CBRF HCBS COMPLIANT (608) 547-6796 Class: AS N9895 18TH AVE ALCOHOL/DRUG DEPENDENT NECEDAH WI 54646 BRENDA FALK-HUZAR Gender - Capacity: M/F - 8 (608) 565-3700 BRENDA FALK-HUZAR PO BOX 10 Low/High rate: 5,180/6,400 DEVELOPMENTALLY DISABLED County: JUNEAU NECEDAH WI 54646 Initial License: 05/01/2013 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING TRAUMATIC BRAIN INJURY Association Approval: WALA WEBER HAUS (110115) WEBER HAUS Type: CBRF ADVANCED AGED (608) 464-7688 Class: CNA 312 CENTER ST IRREVERSIBLE DEMENTIA/ALZHEIM WONEWOC WI 53968 DONNA L WEBER Gender - Capacity: M/F - 8 (608) 464-7688 DONNA L WEBER 515 CENTER ST Low/High rate: 2,200/3,400 PUBLIC FUNDING County: JUNEAU WONEWOC WI 53968 Initial License: 04/30/1985 TERMINALLY ILL ADDISON OF PLEASANT PRAIRIE (THE) (0015999) SHI-II SLD PLEASANT PRAIRIE LLC Type: CBRF ADVANCED AGED (312) 673-4333 Class: CNA 9651 PRAIRIE RIDGE BOULEVARD IRREVERSIBLE DEMENTIA/ALZHEIM PLEASANT PRAIRIE WI 53158 STEPHEN LEVY J Gender - Capacity: M/F - 120 (262) 455-7050 DOLNIK PATRICIA ANN 303 E WACKER DRIVE SUITE 2400 Low/High rate: 4,259/7,100 County: KENOSHA CHICAGO IL 60601 Initial License: 04/28/2016 ADVOCATE HOMES LLC (0012373) ADVOCATE HOMES LLC Type: CBRF HCBS COMPLIANT (847) 565-2522 Class: AA 6555 PERSHING BLVD DEVELOPMENTALLY DISABLED KENOSHA WI 53142 SHERI BLAA Gender - Capacity: M/F - 8 (262) 652-3536 SHERI BLAA 755 DARNELL LN Low/High rate: 4,665/4,800 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA GURNEE IL 60031 Initial License: 05/08/2008 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY AN INNOVATIVE CARE CBRF (0016870) AN INNOVATIVE CARE CBRF INC Type: CBRF HCBS COMPLIANT (847) 370-6328 Class: CA 10628 22ND AVE ADVANCED AGED PLEASANT PRAIRIE WI 53158 RONAK PATEL Gender - Capacity: M/F - 8 (262) 997-3228 RONAK PATEL 10628 22ND AVE Low/High rate: 5,000/8,500 DEVELOPMENTALLY DISABLED County: KENOSHA PLEASANT PRAIRIE WI 53158 Initial License: 07/09/2018 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM TERMINALLY ILL TRAUMATIC BRAIN INJURY ARCHWOOD SENIOR LIVING (0018008) ARCHWOOD SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (224) 538-9449 Class: CNA 25025 75TH STREET ADVANCED AGED SALEM WI 53168 TRENTON CZISNY Gender - Capacity: M/F - 40 (262) 234-0015 ANNETTE LEIVICK W61N1051 GLENWOOD DRIVE Low/High rate: 3,900/6,050 IRREVERSIBLE DEMENTIA/ALZHEIM County: KENOSHA CEDARBURG WI 53012 Initial License: 08/13/2020 PHYSICALLY DISABLED TERMINALLY ILL ASPEN HOME (0013568) CRABTREE RESIDENTIAL LIVING Type: CBRF HCBS COMPLIANT (262) 653-9923 Class: AA 6225 91ST AVE ADVANCED AGED KENOSHA WI 53142 JEFFREY CRABTREE Gender - Capacity: M - 6 (262) 653-9923 STEVE KOELLNER P O BOX 580393 Low/High rate: 4,600/4,600 DEVELOPMENTALLY DISABLED County: KENOSHA KENOSHA WI 53142 Initial License: 11/30/2010 EMOTIONALLY DISTURBED/MENTAL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 56 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

AZALEA PLACE (0015745) FRONTIDA INC Type: CBRF HCBS COMPLIANT (262) 925-9302 Class: CNA 8322 14TH AVENUE ADVANCED AGED KENOSHA WI 53143 CARIN SCHULTZ Gender - Capacity: M/F - 20 (262) 925-9302 AMEER TRIPLETT PO BOX 580254 Low/High rate: 2,800/4,800 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA PLEASANT PRAIRIE WI 53158 Initial License: 02/01/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED AZALEA PLACE (0015745) FRONTIDA INC Type: CBRF HCBS COMPLIANT (262) 925-9302 Class: CNA 8322 14TH AVENUE ADVANCED AGED KENOSHA WI 53143 CARIN SCHULTZ Gender - Capacity: M/F - 20 (262) 925-9302 AMEER TRIPLETT PO BOX 580254 Low/High rate: 2,800/4,800 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA PLEASANT PRAIRIE WI 53158 Initial License: 02/01/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED Association Approval: WALA BIRCH HOME (0012773) CRABTREE RESIDENTIAL LIVING INC Type: CBRF HCBS COMPLIANT (262) 909-4344 Class: AA 1549 25TH AVE DEVELOPMENTALLY DISABLED KENOSHA WI 53140 JEFFREY CRABTREE Gender - Capacity: M/F - 6 (262) 653-9923 MACK CRABTREE PO BOX 580393 Low/High rate: 4,600/4,600 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA PLEASANT PRAIRIE WI 53158 Initial License: 07/27/2009 TRAUMATIC BRAIN INJURY BROOKDALE KENOSHA (0008939) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 10108 74TH ST ADVANCED AGED KENOSHA WI 53142 SARA GODFREY Gender - Capacity: M/F - 60 (262) 694-6101 RANCE MASI 10108 74TH STREET Low/High rate: 3,545/4,995 IRREVERSIBLE DEMENTIA/ALZHEIM County: KENOSHA KENOSHA WI 53142 Initial License: 08/01/2000 PUBLIC FUNDING CASA DEL MARE (0017240) CHIARA COMMUNITIES INC Type: CBRF ADVANCED AGED (262) 798-1224 Class: CNA 3508 7TH AVE IRREVERSIBLE DEMENTIA/ALZHEIM KENOSHA WI 53140 Glen Choban Gender - Capacity: M/F - 27 (262) 653-1234 JENNIFER KESSEL 20875 CROSSROADS CIR STE 400 Low/High rate: 4,300/7,635 PHYSICALLY DISABLED County: KENOSHA WAUKESHA WI 53716 Initial License: 11/01/2018 PUBLIC FUNDING TERMINALLY ILL COTTONWOOD (0013123) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: ANA 5415 ADAMS RD DEVELOPMENTALLY DISABLED KENOSHA WI 53144 CHRISTOPHER COHEN Gender - Capacity: M/F - 6 (262) 652-9724 DENNIS PATTERSON 209 S TAFT STREET Low/High rate: 4,563/9,125 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA WHITEWATER WI 53190 Initial License: 02/05/2010 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY DAYTON CARE CENTER INC (0016409) DAYTON CARE CENTER INC Type: CBRF HCBS COMPLIANT (262) 656-1818 Class: CS 521 59TH STREET ADVANCED AGED KENOSHA WI 53140 OURI MARCIANO Gender - Capacity: M/F - 90 (262) 657-6121 OURI MARCIANO 2124 APPLE TREE RD Low/High rate: 3,000/5,000 DEVELOPMENTALLY DISABLED County: KENOSHA GLENDALE WI 53209 Initial License: 04/26/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM TRAUMATIC BRAIN INJURY EDWARDS HOUSE (310433) VOLUNTEERS OF AMERICA WISCONSIN Type: CBRF HCBS COMPLIANT (414) 847-1515 Class: AS 4831 47TH AVE ADVANCED AGED KENOSHA WI 53144 ALISSA KEMPKEN Gender - Capacity: M/F - 8 (262) 654-3475 ALISSA KEMPKEN 1661 N WATER ST STE 401 Low/High rate: 3,798/5,394 CORRECTIONAL CLIENTS County: KENOSHA MILWAUKEE WI 53202 Initial License: 05/01/1987 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING TRAUMATIC BRAIN INJURY HARBOUR VILLAGE EAST (0013121) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: CNA 1130 82ND ST DEVELOPMENTALLY DISABLED KENOSHA WI 53143 CHRISTOPHER COHEN Gender - Capacity: M/F - 8 (262) 652-1925 SAMANTHA THOMAS 209 S TAFT STREET Low/High rate: 4,563/9,125 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA WHITEWATER WI 53190 Initial License: 02/05/2010 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 57 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HARBOUR VILLAGE WEST (0013120) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: CNA 1150 82ND ST DEVELOPMENTALLY DISABLED KENOSHA WI 53142 CHRISTOPHER COHEN Gender - Capacity: M/F - 8 (262) 653-0842 SAMANTHA THOMAS 209 S TAFT STREET Low/High rate: 4,563/9,125 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA WHITEWATER WI 53190 Initial License: 02/05/2010 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY HOME INSPIRED SENIOR LIVING (0018212) AN INSPIRED CARE LLC Type: CBRF HCBS COMPLIANT (847) 370-6328 Class: CNA 1201 VILLAGE CENTRE DRIVE ADVANCED AGED KENOSHA WI 53144 RONAK PATEL Gender - Capacity: M/F - 32 (262) 859-2500 MARK GIACOMIN 4297 123RD STREET Low/High rate: 4,000/6,500 DEVELOPMENTALLY DISABLED County: KENOSHA MOUNT PLEASANT WI 53158 Initial License: 08/26/2020 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL KARE CENTER (0017066) KENOSHA HUMAN DEVELOPMENT SERVICES IN Type: CBRF ALCOHOL/DRUG DEPENDENT (262) 745-8555 Class: AA 1202 60TH ST EMOTIONALLY DISTURBED/MENTAL KENOSHA WI 53140 JEANNINE FIELD Gender - Capacity: M/F - 16 (262) 654-3586 KARI FOSS 5407 8TH AVE Low/High rate: 9,759/9,759 County: KENOSHA KENOSHA WI 53140 Initial License: 04/03/2018 KENOSHA PLACE 2 (0017873) KENOSHA PLACE SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 5060 GREEN BAY RD ADVANCED AGED KENOSHA WI 53144 THOMAS OSTROM Gender - Capacity: M/F - 32 (262) 652-5149 ELIZABETH PESCHMAN 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: KENOSHA CHICAGO IL 60642 Initial License: 10/21/2019 PHYSICALLY DISABLED TERMINALLY ILL KENOSHA SENIOR LIVING (0015616) KENOSHA SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (262) 656-1795 Class: CNA 3109 30TH AVE ADVANCED AGED KENOSHA WI 53140 Lee Johnson Gender - Capacity: M/F - 45 (262) 752-6369 TIFFANY MORTH 1675 E Riverside Dr.Suite 150 Low/High rate: 2,395/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: KENOSHA Eagle ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING LAKESHORE HEALTH KENOSHA 1 (0017388) LAKESHORE HEALTH KENOSHA LLC Type: CBRF HCBS COMPLIANT (262) 656-1818 Class: AA 6024 18TH AVE ADVANCED AGED KENOSHA WI 53140 MARY PAREDES Gender - Capacity: M - 16 (262) 656-1818 MARY PAREDES 1834 60TH ST Low/High rate: 2,188/4,100 ALCOHOL/DRUG DEPENDENT County: KENOSHA KENOSHA WI 53140 Initial License: 04/01/2019 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM LAKESHORE HEALTH KENOSHA 2 (0017350) LAKESHORE HEALTH KENOSHA LLC Type: CBRF HCBS COMPLIANT (612) 703-3218 Class: AA 5905 19TH AVE ADVANCED AGED KENOSHA WI 53140 MARY PAREDES Gender - Capacity: M/F - 15 (262) 656-1818 MARY PAREDES 1834 60TH ST Low/High rate: 2,188/4,100 ALCOHOL/DRUG DEPENDENT County: KENOSHA KENOSHA WI 53140 Initial License: 04/01/2019 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM LAKESHORE HEALTH KENOSHA 3 (0017349) LAKESHORE HEALTH KENOSHA LLC Type: CBRF HCBS COMPLIANT (612) 703-3218 Class: AA 1834 60TH ST ADVANCED AGED KENOSHA WI 53140 MARY PAREDES Gender - Capacity: - 8 (262) 656-1818 MARY PAREDES 1834 60TH ST Low/High rate: 2,188/4,100 ALCOHOL/DRUG DEPENDENT County: KENOSHA KENOSHA WI 53140 Initial License: 04/01/2019 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM LEGACY AT ST JOSEPHS (THE) (0017767) SAINT JOSEPHS HOME OF OUR LADY OF MOUN Type: CBRF HCBS COMPLIANT (262) 694-0080 Class: CNA 9244 29TH AVE ADVANCED AGED KENOSHA WI 53143 ASI SCHMID-DONDERO Gender - Capacity: M/F - 70 (262) 694-0080 SISTER MARY E APANITES 9244 29TH AVE Low/High rate: 4,000/8,525 IRREVERSIBLE DEMENTIA/ALZHEIM County: KENOSHA KENOSHA WI 53143 Initial License: 12/09/2019 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 58 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LIBRARY TERRACE SUITES (0015729) SCAL KENOSHA LLC Type: CBRF HCBS COMPLIANT (608) 837-2649 Class: CNA 7924 36TH AVENUE ADVANCED AGED KENOSHA WI 53142 MICHAEL COLLINS Gender - Capacity: M/F - 20 (262) 697-7711 COLLEEN ENDSLEY 7905 36TH AVE Low/High rate: 4,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: KENOSHA KENOSHA WI 53142 Initial License: 07/01/2015 PUBLIC FUNDING Association Approval: WALA LINDEN HOME (0012809) CRABTREE RESIDENTIAL LIVING INC Type: CBRF HCBS COMPLIANT (262) 909-4344 Class: AA 3216 29TH ST DEVELOPMENTALLY DISABLED KENOSHA WI 53144 JEFFREY CRABTREE Gender - Capacity: F - 6 (262) 914-8040 MACK CRABTREE PO BOX 580393 Low/High rate: 4,600/4,600 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA PLEASANT PRAIRIE WI 53158 Initial License: 07/27/2009 TRAUMATIC BRAIN INJURY MOORE & ASSOCIATES INC (0016960) MOORE & ASSOCIATES INC Type: CBRF HCBS COMPLIANT (262) 945-7266 Class: AA 2217 56TH ST DEVELOPMENTALLY DISABLED KENOSHA WI 53140 TONY MOORE Gender - Capacity: M/F - 15 (262) 945-7266 TONY MOORE 2217 56TH ST Low/High rate: 1,100/4,000 EMOTIONALLY DISTURBED/MENTAL County: KENOSHA KENOSHA WI 53140 Initial License: 10/31/2017 NORTH POINT SENIOR LIVING (0016740) SOMERS KENOSHA SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (262) 204-7459 Class: CNA 3109 12TH ST ADVANCED AGED KENOSHA WI 53144 LEE JOHNSON Gender - Capacity: M/F - 20 (262) 553-1270 TIFFANY MORTH 1675 E RIVERSIDE DR, STE 200 Low/High rate: 2,000/3,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: KENOSHA EAGLE ID 83616 Initial License: 06/16/2017 PUBLIC FUNDING Association Approval: WiCAL PARKSIDE MANOR (0018350) ENCORE WISCONSIN LLC Type: CBRF ADVANCED AGED (312) 462-4462 Class: CNA 6300 67TH STREET IRREVERSIBLE DEMENTIA/ALZHEIM KENOSHA WI 53142 THOMAS OSTROM Gender - Capacity: M/F - 74 (262) 657-7010 ELIZABETH CARRASCO 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/7,000 PHYSICALLY DISABLED County: KENOSHA CHICAGO IL 60606 Initial License: 02/15/2021 TERMINALLY ILL ROBIN WAY (0017360) AMERICAN EAGLE PLEASANT PRAIRIE LLC Type: CBRF ADVANCED AGED (734) 418-9027 Class: CNA 7377 88TH AVE IRREVERSIBLE DEMENTIA/ALZHEIM KENOSHA WI 53142 DEVIN ANDERSON Gender - Capacity: M/F - 53 (262) 697-7778 LAURA KELTNER 3108 BLUE LAKE DR Low/High rate: 2,870/3,875 PUBLIC FUNDING County: KENOSHA VESTAVIA AL 35243 Initial License: 12/20/2018 SYCAMORE HOME (0012772) CRABTREE RESIDENTIAL LIVING INC Type: CBRF HCBS COMPLIANT (262) 909-4344 Class: AA 9211 66TH ST DEVELOPMENTALLY DISABLED KENOSHA WI 53142 JEFFREY CRABTREE Gender - Capacity: M/F - 6 (262) 960-2700 MACK CRABTREE PO BOX 580393 Low/High rate: 4,600/4,600 County: KENOSHA PLEASANT PRAIRIE WI 53158 Initial License: 07/27/2009 WILLOWBROOK ASSISTED LIVING (0017041) COUNTY OF KENOSHA Type: CBRF ADVANCED AGED (262) 653-3800 Class: CNA 3508 WASHINGTON RD IRREVERSIBLE DEMENTIA/ALZHEIM KENOSHA WI 53144 JENNIFER FAZZARI Gender - Capacity: M/F - 24 (262) 653-3800 LYNDA BOGDALA 3508 WASHINGTON RD Low/High rate: 4,995/7,095 County: KENOSHA KENOSHA WI 53144 Initial License: 05/24/2018 Association Approval: LeadingAge Wisconsin WINDY OAKS (0016909) CURTIS MARTIN LLC Type: CBRF DEVELOPMENTALLY DISABLED (224) 636-2878 Class: AA 11831 120TH CT PUBLIC FUNDING PLEASANT PRAIRIE WI 53158 SHAWNA BESTWICK Gender - Capacity: F - 8 (847) 239-3903 SHAWNA BESTWICK 11831 120TH COURT Low/High rate: 3,410/5,650 County: KENOSHA PLEASANT PRAIRIE WI 53158 Initial License: 02/20/2018 AUTUMN FIELDS (0015388) AUTUMN FIELDS LLC Type: CBRF HCBS COMPLIANT (920) 866-2010 Class: CNA E426 CO RD SS ADVANCED AGED LUXEMBURG WI 54217 LORI HUCEK Gender - Capacity: M/F - 26 (920) 866-2010 LORI HUCEK E426 CTY RD SS Low/High rate: 4,200/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: KEWAUNEE LUXEMBURG WI 54217 Initial License: 03/07/2015 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 59 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

AUTUMNS JOURNEY ASSISTED LIVING LLC (0017475) AUTUMNS JOURNEY ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 837-7284 Class: CNA 500 BAY RD ADVANCED AGED ALGOMA WI 54201 JENNIFER PAVLAT Gender - Capacity: M/F - 25 (920) 487-5500 JENNIFER PAVLAT 500 BAY RD Low/High rate: 3,536/4,160 DEVELOPMENTALLY DISABLED County: KEWAUNEE ALGOMA WI 54201 Initial License: 03/20/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL HELPING HEARTS ASSISTED LIVING LLC (0015336) HELPING HEARTS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 495-5950 Class: CNA 143 SCHOOL CREEK TRL ADVANCED AGED LUXEMBURG WI 54217 PAMELA MILLER Gender - Capacity: M/F - 20 (920) 845-5950 PAMELA J MILLER 143 SCHOOL CREEK TRL Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: KEWAUNEE LUXEMBURG WI 54217 Initial License: 12/01/2014 PHYSICALLY DISABLED TERMINALLY ILL LINDEN MANOR (410404) SECOR Type: CBRF HCBS COMPLIANT (920) 837-2880 Class: CNA 1204 FOURTH ST ADVANCED AGED KEWAUNEE WI 54216 KENNETH SECOR Gender - Capacity: M/F - 16 (920) 388-0110 KENNETH SECOR 1204 FOURTH ST Low/High rate: 3,450/4,660 PHYSICALLY DISABLED County: KEWAUNEE KEWAUNEE WI 54216 Initial License: 01/15/1995 PUBLIC FUNDING OAK CREEK ASSISTED LIVING (0011413) P & J OAKS LLC Type: CBRF HCBS COMPLIANT (920) 973-0855 Class: CNA 409 THIRD ST ADVANCED AGED LUXEMBURG WI 54217 PAM ROSSANO Gender - Capacity: M/F - 20 (920) 845-5835 MARIE PINCHART 409 THIRD ST Low/High rate: 3,250/4,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: KEWAUNEE LUXEMBURG WI 54217 Initial License: 07/01/2006 PHYSICALLY DISABLED TERMINALLY ILL OAK CREEK ASSISTED LIVING ALGOMA (0014875) C AND P OAKS LLC Type: CBRF HCBS COMPLIANT (920) 973-0855 Class: CNA 1505 WASHINGTON ST ADVANCED AGED ALGOMA WI 54201 MARIE PINCHART Gender - Capacity: M/F - 20 (920) 487-8152 MARIE PINCHART 1505 WASHINGTON ST Low/High rate: 2,600/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: KEWAUNEE ALGOMA WI 54201 Initial License: 03/04/2014 PHYSICALLY DISABLED TERMINALLY ILL SILVER LEAF MANOR (410310) SECOR Type: CBRF HCBS COMPLIANT (920) 388-2204 Class: ANA 1310 LINCOLN ST ADVANCED AGED KEWAUNEE WI 54216 KENNETH/MARILYN SECOR Gender - Capacity: M/F - 8 (920) 388-2204 KENNETH SECOR 1310 LINCOLN ST Low/High rate: 3,795/4,800 PUBLIC FUNDING County: KEWAUNEE KEWAUNEE WI 54216 Initial License: 10/09/1992 BLUFFVIEW MEMORY CARE (0014267) HOLMEN ASSISTED LIVING PARTNERS LLC Type: CBRF HCBS COMPLIANT (715) 523-0030 Class: CNA 2101 BLUFFVIEW CT IRREVERSIBLE DEMENTIA/ALZHEIM HOLMEN WI 54636 ANA HINES Gender - Capacity: M/F - 77 (608) 526-5864 ROBERT MCINNES 4407 124TH STREET Low/High rate: 4,500/13,500 County: LACROSSE CHIPPEWA FALLS WI 54729 Initial License: 07/23/2012 BROOKDALE LACROSSE AL (510387) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 3141 EAST AVE SOUTH ADVANCED AGED LACROSSE WI 54601 JENNIFER PETERSON Gender - Capacity: M/F - 36 (608) 788-7730 JENNIFER PETERSON 3141 EAST AVENUE SOUTH Low/High rate: 3,646/6,460 IRREVERSIBLE DEMENTIA/ALZHEIM County: LACROSSE LACROSSE WI 54601 Initial License: 07/28/1998 PUBLIC FUNDING BROOKDALE LACROSSE MC (510386) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 3161 EAST AVE SOUTH ADVANCED AGED LACROSSE WI 54601 JEN PETERSON Gender - Capacity: M/F - 33 (608) 788-2832 JENNIFER PETERSON 3161 E AVENUE SOUTH Low/High rate: 4,980/6,620 IRREVERSIBLE DEMENTIA/ALZHEIM County: LACROSSE LACROSSE WI 54601 Initial License: 07/28/1998 PUBLIC FUNDING BROOKDALE ONALASKA (510379) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 949 10TH AVENUE NORTH ADVANCED AGED ONALASKA WI 54650 LEE LOMAS Gender - Capacity: M/F - 20 (608) 783-4955 LEE LOMAS 949 10TH AVENUE NORTH Low/High rate: 3,945/4,395 IRREVERSIBLE DEMENTIA/ALZHEIM County: LACROSSE ONALASKA WI 54650 Initial License: 11/11/1997 PUBLIC FUNDING CARE CENTER (0013220) TELLURIAN INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 663-2120 Class: AS 4647 MORMON COULEE RD EMOTIONALLY DISTURBED/MENTAL LACROSSE WI 54601 TIM BLUMENTRITT Gender - Capacity: M/F - 10 (608) 519-3080 TIM BLUMENTRITT 4647 MORMON COULEE RD Low/High rate: 8,220/13,950 PUBLIC FUNDING County: LACROSSE LACROSSE WI 54601 Initial License: 05/18/2010

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 60 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CHILEDA INSTITUTE INC (0011556) CHILEDA INSTITUTE INC Type: CBRF DEVELOPMENTALLY DISABLED 1825 VICTORY STREET (608) 782-6480 Class: CNA LACROSSE WI 54601 TERRI GOWEY Gender - Capacity: M/F - 12 (608) 782-6480 DEREK CORTEZ 1825 VICTORY ST Low/High rate: 17,487/17,487 County: LACROSSE LACROSSE WI 54601 Initial License: 08/18/2006 EAGLE CREST NORTH MEMORY CARE (0012129) BETHANY LUTHERAN HOMES INC Type: CBRF HCBS COMPLIANT (608) 406-3887 Class: CNA 351 MASON STREET IRREVERSIBLE DEMENTIA/ALZHEIM ONALASKA WI 54650 KRISTINE FRY Gender - Capacity: M/F - 20 (608) 779-1700 MARISSA JANKE 351 MASON STREET Low/High rate: 4,985/5,370 PUBLIC FUNDING County: LACROSSE ONALASKA WI 54650 Initial License: 01/04/2008 Association Approval: LeadingAge Wisconsin EAGLE CREST SOUTH CBRF (0015685) BETHANY LUTHERAN HOMES, INC Type: CBRF HCBS COMPLIANT (608) 791-2700 Class: CNA 622 BENNORA LEE COURT ADVANCED AGED LACROSSE WI 54601 CARRIE O'HEARN Gender - Capacity: M/F - 103 (608) 791-2700 BRENDA ASPENSON 622 BENNORA LEE COURT Low/High rate: 4,850/5,205 IRREVERSIBLE DEMENTIA/ALZHEIM County: LACROSSE LACROSSE WI 54601 Initial License: 07/06/2015 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin HEARTEN HOUSE I (510185) BETHANY LUTHERAN HOMES INC Type: CBRF HCBS COMPLIANT (608) 406-3982 Class: CNA 2573 S 7TH ST IRREVERSIBLE DEMENTIA/ALZHEIM LACROSSE WI 54601 PATRICK SENZIG Gender - Capacity: M/F - 12 (608) 784-4521 JERRIKA HELLERUD 2575 S 7TH ST Low/High rate: 3,953/4,867 PUBLIC FUNDING County: LACROSSE LACROSSE WI 54601 Initial License: 10/01/1990 Association Approval: LeadingAge Wisconsin HEARTEN HOUSE II (510239) BETHANY LUTHERAN HOMES INC Type: CBRF HCBS COMPLIANT (608) 406-3982 Class: CNA 2571 S 7TH STREET IRREVERSIBLE DEMENTIA/ALZHEIM LACROSSE WI 54601 PATRICK SENZIG Gender - Capacity: M/F - 12 (608) 784-4523 JERRIKA HELLERUD 2575 S 7TH STREET Low/High rate: 3,953/4,867 PUBLIC FUNDING County: LACROSSE LACROSSE WI 54601 Initial License: 12/08/1992 Association Approval: LeadingAge Wisconsin HEARTEN HOUSE III (510260) BETHANY LUTHERAN HOMES INC Type: CBRF HCBS COMPLIANT (608) 406-3982 Class: CNA 101 JUNIPER LANE IRREVERSIBLE DEMENTIA/ALZHEIM HOLMEN WI 54636 AMANDA CHARLESWORTH Gender - Capacity: M/F - 12 (608) 526-6796 MARISSA JANKE 101 JUNIPER LANE Low/High rate: 3,878/4,958 PUBLIC FUNDING County: LACROSSE HOLMEN WI 54636 Initial License: 12/08/1993 Association Approval: LeadingAge Wisconsin MAPLEWOOD CBRF (0016342) LA CROSSE COUNTY DBA MAPLEWOOD Type: CBRF HCBS COMPLIANT (608) 786-1400 Class: CNA 994 E GARLAND ST EMOTIONALLY DISTURBED/MENTAL WEST SALEM WI 54669 JESSICA GJERTSEN Gender - Capacity: M/F - 15 (608) 612-0666 WANDA PLACHECKI 994 E GARLAND ST Low/High rate: 4,106/5,300 PHYSICALLY DISABLED County: LACROSSE WEST SALEM WI 54669 Initial License: 10/18/2016 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin MEADOWS AT SPRINGBROOK (THE) (0013768) SPRINGBROOK COMMUNITY ASSISTED LIVING I Type: CBRF HCBS COMPLIANT (608) 783-2292 Class: CNA 861 CRITTER CT ADVANCED AGED ONALASKA WI 54650 ROBERT SIMONSON Gender - Capacity: M/F - 46 (608) 783-2292 MARCIA HITZ 2850 MONARCH COURT Low/High rate: 3,700/5,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: LACROSSE ALTOONA WI 54720 Initial License: 10/17/2011 PUBLIC FUNDING MONARCH MANOR (0015070) LACROSSE COUNTY DBA MONARCH MANOR Type: CBRF HCBS COMPLIANT (608) 786-1400 Class: CNA 848 EAST GARLAND STREET DEVELOPMENTALLY DISABLED WEST SALEM WI 54669 WANDA PLACHECKI Gender - Capacity: M/F - 8 (608) 786-1400 WANDA PLACHECKI 962 GARLAND STREET EAST Low/High rate: 4,563/12,600 PHYSICALLY DISABLED County: LACROSSE WEST SALEM WI 54669 Initial License: 06/16/2014 Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 61 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

NESHONOC MANOR CBRF (0016314) LA CROSSE COUNTY DBA NESHONOC MANOR Type: CBRF HCBS COMPLIANT (608) 786-1400 Class: CNA 998 E GARLAND STREET ADVANCED AGED WEST SALEM WI 54669 JESSICA GJERTSEN Gender - Capacity: M/F - 15 (608) 612-0661 WANDA PLACHECKI 998 E GARLAND ST Low/High rate: 4,700/7,600 EMOTIONALLY DISTURBED/MENTAL County: LACROSSE WEST SALEM WI 54669 Initial License: 10/18/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: LeadingAge Wisconsin RBI CARING HEARTS A LLC (0016005) RBI CARING HEARTS LLC Type: CBRF HCBS COMPLIANT (608) 269-0386 Class: CNA 1612 HENRY JOHNS BLVD ADVANCED AGED BANGOR WI 54614 LYNETTE SCHMITZ Gender - Capacity: M/F - 10 (608) 486-4801 LYNETTE SCHMITZ 402 S BLACK RIVER ST Low/High rate: 4,000/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: LACROSSE SPARTA WI 54656 Initial License: 04/01/2016 PHYSICALLY DISABLED PUBLIC FUNDING RBI CARING HEARTS B LLC (0016004) RBI CARING HEARTS LLC Type: CBRF HCBS COMPLIANT (608) 269-0386 Class: CNA 1614 HENRY JOHNS BLVD ADVANCED AGED BANGOR WI 54614 LYNETTE SCHMITZ Gender - Capacity: M/F - 12 (608) 486-4210 LYNETTE SCHMITZ 402 S BLACK RIVER ST STE 105 Low/High rate: 4,000/ IRREVERSIBLE DEMENTIA/ALZHEIM County: LACROSSE SPARTA WI 54656 Initial License: 05/01/2016 PHYSICALLY DISABLED UNITY HOUSE FOR MEN (510119) GUNDERSEN LUTHERAN MEDICAL CENTER INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 775-6439 Class: AA 1922-1924 MILLER ST PUBLIC FUNDING LACROSSE WI 54601 JOSH COURT Gender - Capacity: M - 8 (608) 775-4753 JOSH COURT 1900 SOUTH AVE Low/High rate: 13,710/20,640 County: LACROSSE LACROSSE WI 54601 Initial License: 02/16/1981 UNITY HOUSE FOR WOMEN (510151) GUNDERSEN LUTHERAN MEDICAL CENTER INC Type: CBRF ALCOHOL/DRUG DEPENDENT 1312-5TH AVE S (608) 785-0530 Class: AA LACROSSE WI 54601 JOSH COURT Gender - Capacity: F - 8 (608) 775-4718 ANNE BERGET 1900 SOUTH AVE Low/High rate: 13,230/19,830 County: LACROSSE LACROSSE WI 54601 Initial License: 08/01/1989 M & M GROUP HOME (110270) MADELINE FLOGEL Type: CBRF HCBS COMPLIANT (608) 348-9954 Class: CS 30068 COUNTY B DEVELOPMENTALLY DISABLED PLATTEVILLE WI 53818 MADELINE FLOGEL Gender - Capacity: M - 8 (608) 348-9954 MADELINE FLOGEL 30068 COUNTY B Low/High rate: 2,330/4,133 County: LAFAYETTE PLATTEVILLE WI 53818 Initial License: 11/01/1989 SHULLSBURG HOME CBRF (110186) SHULLSBURG MEMORIAL HOSPITAL ASSOCIATI Type: CBRF HCBS COMPLIANT (608) 965-4454 Class: CNA 204 E WATER ST ADVANCED AGED SHULLSBURG WI 53586 THERESA SPILLANE Gender - Capacity: M/F - 17 (608) 965-4454 THERESA SPILLANE 204 E WATER ST Low/High rate: 2,500/3,250 DEVELOPMENTALLY DISABLED County: LAFAYETTE SHULLSBURG WI 53586 Initial License: 02/28/1982 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING SIENNA CREST DARLINGTON (0009501) SIENNA CREST ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (608) 835-0040 Class: CNA 1619 FAYETTE RD ADVANCED AGED DARLINGTON WI 53530 SUSAN WHITE Gender - Capacity: M/F - 15 (608) 776-3477 SUSAN WHITE 845 MARKET STREET, SUITE 1 Low/High rate: 3,780/5,280 IRREVERSIBLE DEMENTIA/ALZHEIM County: LAFAYETTE OREGON WI 53575 Initial License: 10/29/2001 PUBLIC FUNDING BAY AT GARDEN VIEW ASSISTED LIVING CENTER (THE) BAY AT GARDEN VIEW ASSISTED LIVING CENTE Type: CBRF ADVANCED AGED (715) 623-2356 Class: CNA 729 PARK STREET PHYSICALLY DISABLED ANTIGO WI 54409 THERESA HUNT Gender - Capacity: M/F - 20 (715) 623-2356 THERESA HUNT 729 PARK STREET Low/High rate: 4,500/6,000 TERMINALLY ILL County: LANGLADE ANTIGO WI 54409 Initial License: 10/01/2018 Association Approval: WiCAL CARE PARTNERS ASSISTED LIVING ANTIGO I (0014921) CARE PARTNERS ASSISTED LIVING Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1417 10TH AVENUE ADVANCED AGED ANTIGO WI 54409 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 350-4522 ALEXANDRA CAUDELL PO BOX 3006 Low/High rate: 3,800/4,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: LANGLADE OSHKOSH WI 54903 Initial License: 02/13/2014 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 62 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CARE PARTNERS ASSISTED LIVING ANTIGO II (0014663) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1415 10TH AVE ADVANCED AGED ANTIGO WI 54409 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 627-4698 ALEXANDRA CAUDELL P O BOX 3006 Low/High rate: 4,200/5,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: LANGLADE OSHKOSH WI 54903 Initial License: 09/17/2013 TERMINALLY ILL EVERGREEN TERRACE LLC (611048) EVERGREEN TERRACE LLC Type: CBRF HCBS COMPLIANT (715) 623-0423 Class: CNA 715 ACKLEY STREET ADVANCED AGED ANTIGO WI 54409 GARY VOYTOVICH Gender - Capacity: M/F - 24 (715) 623-0423 GARY VOYTOVICH 715 ACKLEY STREET Low/High rate: 4,250/7,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: LANGLADE ANTIGO WI 54409 Initial License: 10/06/1998 PUBLIC FUNDING TERMINALLY ILL EVERGREEN TERRACE LLC (611048) EVERGREEN TERRACE LLC Type: CBRF HCBS COMPLIANT (715) 623-0423 Class: CNA 715 ACKLEY STREET ADVANCED AGED ANTIGO WI 54409 GARY VOYTOVICH Gender - Capacity: M/F - 24 (715) 623-0423 GARY VOYTOVICH 715 ACKLEY STREET Low/High rate: 4,250/7,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: LANGLADE ANTIGO WI 54409 Initial License: 10/06/1998 PUBLIC FUNDING TERMINALLY ILL Association Approval: WALA ROSALIA GARDENS (0008499) LANGLADE HOSPITAL HOTEL DIEU OF ST JOSEP Type: CBRF HCBS COMPLIANT (715) 623-2331 Class: CNA 519 FLIGHT ROAD ADVANCED AGED ANTIGO WI 54409 DEBRA WITMAN Gender - Capacity: M/F - 43 (715) 627-2613 DEBRA WITMAN 519 FLIGHT ROAD Low/High rate: 4,244/5,180 IRREVERSIBLE DEMENTIA/ALZHEIM County: LANGLADE ANTIGO WI 54409 Initial License: 02/03/1999 PUBLIC FUNDING BELL TOWER RESIDENCE (0017638) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (303) 980-0611 Class: CNA 1500 ODAY ST ADVANCED AGED MERRILL WI 54452 KRIS MCCARIGLE Gender - Capacity: M/F - 90 (715) 536-5575 KRIS MCCARIGLE 1500 ODAY ST Low/High rate: 2,928/5,990 IRREVERSIBLE DEMENTIA/ALZHEIM County: LINCOLN MERRILL WI 54452 Initial License: 07/20/2020 PHYSICALLY DISABLED COUNTRY TERRACE TOMAHAWK (0015263) COUNTRY TERRACE Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 300 THEILER STREET ADVANCED AGED TOMAHAWK WI 54487 JASON LINDEMANN Gender - Capacity: - 33 (715) 224-3701 ZENA YOUNG PO BOX 3006 Low/High rate: 3,800/4,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: LINCOLN OSHKOSH WI 54903 Initial License: 10/01/2014 PHYSICALLY DISABLED TERMINALLY ILL MILESTONE SENIOR LIVING LINCOLN CBRF (0017059) ABILIT HOLDINGS TOMAHAWK LLC Type: CBRF ADVANCED AGED (858) 500-6793 Class: CNA 314 E LINCOLN AVE IRREVERSIBLE DEMENTIA/ALZHEIM TOMAHAWK WI 54487 AMY LEMKE Gender - Capacity: M/F - 22 (715) 224-3740 CAROLE MIETELSKI 208 35TH ST DR SE STE 500 Low/High rate: 5,300/6,600 County: LINCOLN CEDAR RAPIDS IA 52403-1361 Initial License: 05/18/2018 PAT WEBER HOME (0018216) OUR WAY INC Type: CBRF HCBS COMPLIANT (715) 218-8650 Class: CNA 1209 WEST TAYLOR STREET ADVANCED AGED MERRILL WI 54452 RIANNON KLEINSCHMIDT Gender - Capacity: M/F - 8 (715) 722-0980 RIANNON KLEINSCHMIDT PO BOX 917 Low/High rate: 4,036/10,221 DEVELOPMENTALLY DISABLED County: LINCOLN MERRILL WI 54452 Initial License: 09/17/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY RESCARE RAILWAY (0016944) RESCARE RESIDENTIAL SERVICES WISCONSIN Type: CBRF HCBS COMPLIANT (502) 394-2100 Class: CNA 18 S RAILWAY ST DEVELOPMENTALLY DISABLED TOMAHAWK WI 54487 NICOLE MCMILLAN Gender - Capacity: M/F - 8 (715) 453-7615 NICOLE MCMILLAN 383 WILLIAMSTOWNE, SUITE 201 Low/High rate: 3,705/5,133 PUBLIC FUNDING County: LINCOLN DELAFIELD WI 53018 Initial License: 11/01/2017 WOODLAND COURT ELDER SERVICES LLC (0008890) DARREL/MELISSA DENGEL Type: CBRF HCBS COMPLIANT (715) 539-9700 Class: CNA 1102 SOUTH CENTER AVENUE ADVANCED AGED MERRILL WI 54452 MELISSA DENGEL Gender - Capacity: M/F - 15 (715) 539-9700 MELISSA DENGEL 1102 SOUTH CENTER AVENUE Low/High rate: 3,000/3,900 DEVELOPMENTALLY DISABLED County: LINCOLN MERRILL WI 54452 Initial License: 03/30/2000 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 63 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

WOODLAND COURT ELDER SERVICES LLC II (0009754) DARREL&MELISSA DENGEL Type: CBRF HCBS COMPLIANT (715) 536-3399 Class: CNA 1102 SOUTH CENTER AVENUE #2 ADVANCED AGED MERRILL WI 54452 MELISSA DENGEL Gender - Capacity: M/F - 15 (715) 536-3399 MELISSA DENGEL 1102 SOUTH CENTER AVENUE Low/High rate: 3,000/3,900 DEVELOPMENTALLY DISABLED County: LINCOLN MERRILL WI 54452 Initial License: 11/12/2002 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL AZURA MEMORY CARE OF MANITOWOC (0013437) AZURA MANITOWOC LLC Type: CBRF HCBS COMPLIANT (720) 838-2901 Class: CNA 3720 MENASHA AVE ADVANCED AGED MANITOWOC WI 54220 JILL KREIDER Gender - Capacity: M/F - 9 (920) 682-5744 JUSTINE CHIQUITO 1233 N MAYFAIR RD STE 301 Low/High rate: 5,100/8,025 IRREVERSIBLE DEMENTIA/ALZHEIM County: MANITOWOC MILWAUKEE WI 53226 Initial License: 08/15/2010 CARE PARTNERS MANITOWOC (0009054) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1858 MIRRO DR ADVANCED AGED MANITOWOC WI 54220 JASON LINDEMANN Gender - Capacity: M/F - 15 (920) 684-2077 MARIBEL TRUETT PO BOX 3006 Low/High rate: 1,995/3,645 IRREVERSIBLE DEMENTIA/ALZHEIM County: MANITOWOC OSHKOSH WI 54903 Initial License: 07/05/2000 PHYSICALLY DISABLED TERMINALLY ILL FIELD OF DREAMS ASSISTED LIVING (0014283) FIELD OF DREAMS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (608) 432-1470 Class: CNA 505 BELITZ DR ADVANCED AGED KIEL WI 53042 SCOTT A LEWIS Gender - Capacity: M/F - 24 (920) 286-6189 DEBORAH KIENBAUM 505 BELITZ DR Low/High rate: 3,400/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MANITOWOC KIEL WI 53042 Initial License: 10/26/2012 PHYSICALLY DISABLED TERMINALLY ILL FIELDCREST MANOR (0016554) NORTH OAK HEALTH CARE INC Type: CBRF HCBS COMPLIANT (847) 612-0750 Class: CS 1510 S 30TH ST ADVANCED AGED MANITOWOC WI 54220 DEAN C MASCHOFF Gender - Capacity: M/F - 20 (920) 682-8980 LAURA RUELLE 1510 S 30TH ST Low/High rate: 2,196/3,000 DEVELOPMENTALLY DISABLED County: MANITOWOC MANITOWOC WI 54220 Initial License: 04/14/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM HANNAH HOME (0009173) SCHISEL Type: CBRF HCBS COMPLIANT (920) 684-4717 Class: CNA 4025 DELTA ST ADVANCED AGED MANITOWOC WI 54220 ANNETTE SCHISEL Gender - Capacity: M/F - 8 (920) 686-1131 ANNETTE SCHISEL 3110 POPLAR RD Low/High rate: 3,150/4,050 DEVELOPMENTALLY DISABLED County: MANITOWOC MANITOWOC WI 54220 Initial License: 11/09/2000 IRREVERSIBLE DEMENTIA/ALZHEIM HANNAH HOME II (0013211) ANNETTE M SCHISEL Type: CBRF HCBS COMPLIANT (920) 684-4717 Class: CNA 3407 WILDWOOD DR ADVANCED AGED MANITOWOC WI 54220 ANNETTE M SCHISEL Gender - Capacity: M/F - 7 (920) 686-1811 ANNETTE M SCHISEL 3110 POPLAR RD Low/High rate: 3,555/4,355 DEVELOPMENTALLY DISABLED County: MANITOWOC MANITOWOC WI 54220 Initial License: 03/02/2010 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED HARBOR VIEW ASSISTED LIVING (0015630) MANITOWOC SENIOR LVING INC Type: CBRF HCBS COMPLIANT (920) 686-1797 Class: CNA 2115 CAPPAERT RD ADVANCED AGED MANITOWOC WI 54220 LEE JOHNSON Gender - Capacity: M/F - 43 (920) 686-1797 TAMMY WAGNER 1675 E RIVERSIDE DR STE 150 Low/High rate: 2,550/5,823 IRREVERSIBLE DEMENTIA/ALZHEIM County: MANITOWOC EAGLE ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL HIL NEWPORT HOME (0009730) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AA 3609 HECKER RD DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ASHLEY WILLIAMS Gender - Capacity: M/F - 8 (920) 684-8755 KAREN SCHULTZ 1249 RUSSETT COURT Low/High rate: 5,049/5,049 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC GREEN BAY WI 54313 Initial License: 01/01/2002 PUBLIC FUNDING TRAUMATIC BRAIN INJURY HIL THE WINDS (0016348) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT () - Class: CNA 2408 KNUELL STREET DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ASHLEY WILLIAMS Gender - Capacity: M/F - 8 (920) 683-9308 KAREN SCHULTZ 1249 RUSSETT COURT Low/High rate: 6,814/6,814 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC GREEN BAY WI 54313 Initial License: 03/08/2017 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 64 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HIL WHITETAIL COURT (0014007) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AS 4705 WHITETAIL CT DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ASHLEY WILLIAMS Gender - Capacity: M/F - 8 (920) 682-6854 KAREN SCHULTZ 1249 RUSSETT COURT Low/High rate: 3,810/3,810 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC GREEN BAY WI 54313 Initial License: 02/29/2012 PUBLIC FUNDING TRAUMATIC BRAIN INJURY HIL WISCONSIN HOME (0009731) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CA 1348-1350 S 39TH ST DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ASHLEY WILLIAMS Gender - Capacity: M/F - 7 (920) 682-6594 KAREN SCHULTZ 1249 RUSSETT COURT Low/High rate: 4,350/4,350 PUBLIC FUNDING County: MANITOWOC GREEN BAY WI 54313 Initial License: 01/01/2002 KINDREDHEARTS MANITOWOC (0009723) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 5005 VISTA RD ADVANCED AGED MANITOWOC WI 54220 DOUGLAS HENNIG Gender - Capacity: M/F - 20 (608) 513-2122 JESSICA PARKERSON P.O. Box 129 Low/High rate: 3,780/3,933 IRREVERSIBLE DEMENTIA/ALZHEIM County: MANITOWOC GREEN LAKE WI 54941 Initial License: 10/02/2002 PUBLIC FUNDING LAUREL GROVE ASSISTED LIVING CENTER (0009274) SHADY LANE INC Type: CBRF HCBS COMPLIANT (920) 682-8254 Class: CNA 1235 S 24TH ST ADVANCED AGED MANITOWOC WI 54220 TODD MEERDINK Gender - Capacity: M/F - 145 (920) 682-8254 TODD MEERDINK 1235 S 24TH ST Low/High rate: 2,895/6,000 PUBLIC FUNDING County: MANITOWOC MANITOWOC WI 54220 Initial License: 06/06/2001 Association Approval: LeadingAge Wisconsin MAGNOLIA MEADOWS (0017668) NOHC MAGNOLIA MEADOWS LLC Type: CBRF HCBS COMPLIANT (847) 612-0750 Class: CNA 1480 N 7TH ST ADVANCED AGED MANITOWOC WI 54220 DEAN MASCHOFF Gender - Capacity: M/F - 21 (920) 686-0160 CHRISTINA BRUECHERT 1480 N 7TH ST Low/High rate: 2,742/4,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: MANITOWOC MANITOWOC WI 54220 Initial License: 08/01/2019 TERMINALLY ILL MEADOW VIEW ASSISTED LIVING (0015626) TWO RIVERS SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 794-1950 Class: CNA 4606 MISHICOT RD ADVANCED AGED TWO RIVERS WI 54241 LEE JOHNSON Gender - Capacity: M/F - 28 (920) 794-1950 CHRISTINA MESEBERG 1675 E RIVERSIDE DR STE 150 Low/High rate: 2,460/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: MANITOWOC EAGLE ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL PATHWAYS TO A BETTER LIFE 1 LLC (0015350) SUSAN BEATTIE Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 894-1374 Class: AA 13111 LAX CHAPEL RD EMOTIONALLY DISTURBED/MENTAL KIEL WI 53042 SUSAN BEATTIE Gender - Capacity: M/F - 8 (920) 894-1374 SUSAN BEATTIE 13111 LAX CHAPEL RD Low/High rate: 6,750/30,000 PREGNANT WOMEN/COUNSELLING County: MANITOWOC KIEL WI 53042 Initial License: 04/01/2015 PUBLIC FUNDING PATHWAYS TO A BETTER LIFE 2 LLC (0015351) SUSAN BEATTIE Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 894-1374 Class: AA 13127 LAX CHAPEL RD EMOTIONALLY DISTURBED/MENTAL KIEL WI 53042 SUSAN BEATTIE Gender - Capacity: M/F - 8 (920) 894-1374 SUSAN BEATTIE 10406 RABE RD Low/High rate: 6,750/30,000 PREGNANT WOMEN/COUNSELLING County: MANITOWOC KIEL WI 53042 Initial License: 04/01/2015 PUBLIC FUNDING POINT CREEK HOME (410554) MANRING Type: CBRF HCBS COMPLIANT (920) 901-1063 Class: AA 1722 NEW YORK AVE ADVANCED AGED MANITOWOC WI 54220 JOLEEN MANRING Gender - Capacity: M/F - 8 (920) 683-9388 JOLEEN MANRING PO BOX 1716 Low/High rate: 2,900/3,400 DEVELOPMENTALLY DISABLED County: MANITOWOC MANITOWOC WI 54220-3144 Initial License: 01/13/1996 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING RAINBOW HOUSE (0011339) MARCIA CHRISTIANSEN Type: CBRF HCBS COMPLIANT (920) 683-3697 Class: CNA 3100 SOUTHBROOK CT DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 MARCIA CHRISTIANSEN Gender - Capacity: M/F - 8 (920) 684-4851 MARCIA M CHRISTIANSEN 3100 SOUTHBROOK CT Low/High rate: 5,728/6,580 County: MANITOWOC MANITOWOC WI 54220 Initial License: 12/21/2006 Association Approval: WiCAL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 65 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SAMARITAN HOME ON 43RD (0017286) VICHIL PROPERTIES LLC Type: CBRF ADVANCED AGED (920) 207-8453 Class: CNA 1024 N 43RD ST DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 DONALD LAST Gender - Capacity: M/F - 8 (920) 207-8453 TINA LAST W3329 SUNSET RD Low/High rate: 5,800/6,500 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC SHEBOYGAN FALLS WI 53085 Initial License: 11/01/2018 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: WALA SAMARITAN HOME ON 7TH (0014582) VICHIL PROPERTIES LLC Type: CBRF HCBS COMPLIANT (920) 467-6303 Class: AS 622 NORTH 7TH ST ADVANCED AGED MANITOWOC WI 54220 DONALD LAST Gender - Capacity: F - 8 (920) 682-5237 TINA L LAST W3329 SUNSET RD Low/High rate: 2,400/2,800 DEVELOPMENTALLY DISABLED County: MANITOWOC SHEBOYGAN FALLS WI 53085 Initial License: 05/28/2013 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING Association Approval: WALA ST CLAIR CONVENT (0017946) CORE TREATMENT SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 645-1411 Class: AA 3 RIVERVIEW DRIVE PUBLIC FUNDING MANITOWOC WI 54220 CARMEN PERSAUD Gender - Capacity: M/F - 16 (920) 645-1411 CARMEN PERSAUD 3 RIVERVIEW DRIVE Low/High rate: 6,000/9,000 County: MANITOWOC MANITOWOC WI 54220 Initial License: 03/06/2020 SYLVAN CROSSING AT MARITIME GARDENS (0018270) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 277-8887 Class: CNA 1945 DEWEY STREET ADVANCED AGED MANITOWOC WI 54220 DANIEL FLEMING Gender - Capacity: M/F - 26 (920) 682-1945 JANET BELL 2960 TRIVERTON PIKE DRIVE Low/High rate: 500/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MANITOWOC MADISON WI 53711 Initial License: 12/25/2020 PHYSICALLY DISABLED TERMINALLY ILL TENDER REFLECTIONS OF MANITOWOC (0016370) MIDWEST ASSISTED LIVING PARTNERS II LLC Type: CBRF HCBS COMPLIANT (715) 726-9330 Class: CNA 2210 DUFEK DRIVE ADVANCED AGED MANITOWOC WI 54220 CURT CROTTY Gender - Capacity: M/F - 55 (920) 652-0537 ANDREA CUESTAS 13663 245TH AVE Low/High rate: 3,000/7,000 DEVELOPMENTALLY DISABLED County: MANITOWOC BLOOMER WI 54724 Initial License: 11/07/2016 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM TERMINALLY ILL TRAUMATIC BRAIN INJURY VILLA (THE) (0012792) ST MARYS HOME FOR THE AGED Type: CBRF ADVANCED AGED (920) 684-7171 Class: CNA 1600 S 18TH ST IRREVERSIBLE DEMENTIA/ALZHEIM MANITOWOC WI 54220 KATHERINE KOPENSKI Gender - Capacity: M/F - 35 (920) 684-7171 KATHERINE KOPENSKI 1600 S 18TH ST Low/High rate: 4,856/6,410 County: MANITOWOC MANITOWOC WI 54220 Initial License: 05/15/2009 Association Approval: LeadingAge Wisconsin VISTA CARE CAPPAERT ROAD (0015812) VISTA CARE WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 694-1102 Class: CNA 2233 CAPPAERT RD DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ROBERT BACHICHA Gender - Capacity: M/F - 8 (920) 694-1121 ROBERT BACHICHA 708 ERIE AVE SUITE 201 Low/High rate: 3,043/3,875 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC SHEBOYGAN WI 53081 Initial License: 09/14/2015 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY VISTA CARE FLEETWOOD DRIVE (0014314) VISTA CARE WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 457-0826 Class: CNA 4438 FLEETWOOD DR DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ROBERT BACHICHA Gender - Capacity: M/F - 8 (920) 694-1192 ROBERT BACHICHA 708 ERIE AVE STE 201 Low/High rate: 3,800/5,250 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC SHEBOYGAN WI 53081 Initial License: 02/05/2013 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY VISTA CARE MARSHALL STREET (0015675) VISTA CARE WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 694-1102 Class: AA 2303 MARSHALL ST DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ROBERT BACHICHA Gender - Capacity: M/F - 8 (920) 395-9974 ROBERT BACHICHA 708 ERIE AVE STE 201 Low/High rate: 3,600/3,600 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC SHEBOYGAN WI 53081 Initial License: 05/18/2015 TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 66 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

VISTA CARE OAKWOOD (0015673) VISTA CARE WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 457-0826 Class: AA 1220 S 8TH ST DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ROBERT BACHICHA Gender - Capacity: M/F - 8 (920) 686-9266 ROBERT BACHICHA 708 ERIE AVE STE 201 Low/High rate: 4,750/4,750 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC SHEBOYGAN WI 53081 Initial License: 05/18/2015 PUBLIC FUNDING TRAUMATIC BRAIN INJURY VISTA CARE PAUL ROAD (0015359) VISTA CARE WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 694-1102 Class: CNA 2213 PAUL RD DEVELOPMENTALLY DISABLED MANITOWOC WI 54220 ROBERT BACHICHA Gender - Capacity: M/F - 8 (920) 694-1185 ROBERT BACHICHA 708 ERIE AVE STE 201 Low/High rate: 3,043/3,875 EMOTIONALLY DISTURBED/MENTAL County: MANITOWOC SHEBOYGAN WI 53081 Initial License: 01/22/2015 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY WHITETAIL ESTATES RIVER BLUFF LLC (0017569) WHITETAIL ESTATES RIVER BLUFF LLC Type: CBRF HCBS COMPLIANT (920) 645-8419 Class: AS 910 RIVER BLUFF DR ADVANCED AGED MANITOWOC WI 54220 RACHEL KARSTAEDT Gender - Capacity: M/F - 8 (920) 686-1981 RACHEL KARSTAEDT 910 RIVER BLUFF DR Low/High rate: 2,200/4,200 PUBLIC FUNDING County: MANITOWOC MANITOWOC WI 54220 Initial License: 10/01/2019 WISTERIA HAUS ASSISTED LIVING (0016823) NORTH OAK HEALTH CARE WISTERIA HAUS LLC Type: CBRF HCBS COMPLIANT (847) 612-0750 Class: CNA 2741 45TH STREET ADVANCED AGED TWO RIVERS WI 54241 DEAN MASCHOFF Gender - Capacity: M/F - 17 (920) 793-1520 VICKY SWOBODA PO BOX 1266 Low/High rate: 0/3,800 County: MANITOWOC NORTHBROOK IL 60062 Initial License: 09/29/2017 ANDREA STREET COMMUNITY RESIDENCE (0016537) NORTH CENTRAL HEALTH CARE Type: CBRF HCBS COMPLIANT (715) 848-4600 Class: CNA 9205 ANDREA STREET DEVELOPMENTALLY DISABLED WESTON WI 54476 TONI KELLNER Gender - Capacity: M/F - 8 (715) 848-4405 MICHAEL LOY 1100 LAKEVIEW DR Low/High rate: 4,206/6,300 EMOTIONALLY DISTURBED/MENTAL County: MARATHON WAUSAU WI 54403 Initial License: 06/01/2017 TRAUMATIC BRAIN INJURY APPLEGATE REFLECTIONS (0016883) NSH APPLEGATE LLC Type: CBRF ADVANCED AGED (414) 962-5250 Class: CNA 3001 WESTHILL DR IRREVERSIBLE DEMENTIA/ALZHEIM WAUSAU WI 54401 JEFFREY HOEHN Gender - Capacity: M/F - 8 (715) 849-1514 ERICA POOLE 640N VEL R PHILLIPS AVE STE200 Low/High rate: 5,309/5,341 PHYSICALLY DISABLED County: MARATHON MILWAUKEE WI 53203 Initial License: 10/01/2017 ARTISAN WAUSAU (THE) (0014435) MOSAIC MANAGEMENT GROUP LLC Type: CBRF HCBS COMPLIANT (262) 754-4800 Class: CNA 111 NORTH BELLIS STREET ADVANCED AGED WAUSAU WI 54403 KRISTA MCCOOK Gender - Capacity: M/F - 18 (715) 849-2740 BETH VUKOBRAT 15400 W CAPITOL DR STE 100 Low/High rate: 2,420/4,900 EMOTIONALLY DISTURBED/MENTAL County: MARATHON BROOKFIELD WI 53005 Initial License: 12/01/2012 IRREVERSIBLE DEMENTIA/ALZHEIM AZURA MEMORY CARE OF WAUSAU (0013419) AZURA WAUSAU LLC Type: CBRF HCBS COMPLIANT (715) 355-0812 Class: CNA 3704 HUMMINGBIRD RD ADVANCED AGED WAUSAU WI 54401 JILL KREIDER Gender - Capacity: M/F - 19 (715) 355-0812 SHERIDAN PETERSON 1233 N MAYFAIR ROAD STE 301 Low/High rate: 5,000/6,825 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON MILWAUKEE WI 53226 Initial License: 08/15/2010 BACK COUNTRY MANOR (0011758) SHANE TED BOE Type: CBRF HCBS COMPLIANT (715) 659-4389 Class: AS 104995 BACK COUNTRY RD ADVANCED AGED SPENCER WI 54479 SHANE BOE Gender - Capacity: M/F - 8 (715) 659-4729 SHANE BOE 105115 BACK COUNTRY RD Low/High rate: 2,800/2,800 DEVELOPMENTALLY DISABLED County: MARATHON SPENCER WI 54479 Initial License: 02/07/2007 PUBLIC FUNDING BISSELL STREET COMMUNITY RESIDENCE (610159) NORTH CENTRAL HEALTH CARE Type: CBRF HCBS COMPLIANT (715) 848-4477 Class: CNA 1408 BISSELL STREET DEVELOPMENTALLY DISABLED WAUSAU WI 54401 TONI KELLNER Gender - Capacity: M - 8 (715) 675-4252 NANCY SCHULZ 1100 LAKEVIEW DRIVE Low/High rate: 4,743/7,950 EMOTIONALLY DISTURBED/MENTAL County: MARATHON WAUSAU WI 54403 Initial License: 11/12/1991 PHYSICALLY DISABLED PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 67 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CADY HOME WEST 1 (0017995) CADY MEMORIAL HOME INC Type: CBRF HCBS COMPLIANT (715) 449-3177 Class: CNA 1805 NORTH 6TH AVENUE ADVANCED AGED WAUSAU WI 54401 TRACY ANDERSON Gender - Capacity: M/F - 8 (715) 675-5487 TRACY ANDERSON PO BOX 220 Low/High rate: 2,500/4,000 DEVELOPMENTALLY DISABLED County: MARATHON BIRNAMWOOD WI 54414 Initial License: 03/06/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CADY HOME WEST 2 (0017996) CADY MEMORIAL HOME INC Type: CBRF HCBS COMPLIANT (715) 449-3177 Class: CNA 1815 NORTH 6TH AVENUE ADVANCED AGED WAUSAU WI 54401 TRACY ANDERSON Gender - Capacity: M/F - 8 (715) 675-5726 TRACY ANDERSON PO BOX 220 Low/High rate: 2,500/4,000 DEVELOPMENTALLY DISABLED County: MARATHON BIRNAMWOOD WI 54414 Initial License: 03/06/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CARE PARTNERS ASSISTED LIVING WESTON (0011313) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 5855 DELIKOWSKI STREET ADVANCED AGED WESTON WI 54476 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 355-0322 PETTI MANNEL PO BOX 3006 Low/High rate: 3,200/3,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON OSHKOSH WI 54903 Initial License: 02/15/2006 PHYSICALLY DISABLED TERMINALLY ILL CARE PARTNERS ASSISTED LIVING WESTON II (0013949 CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 5905 DELIKOWSKI ST ADVANCED AGED WESTON WI 54476 JASON LINDEMANN Gender - Capacity: M/F - 20 (715) 298-1688 PETTI MANNEL P O BOX 3006 Low/High rate: 3,700/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON OSHKOSH WI 54903 Initial License: 11/14/2011 PHYSICALLY DISABLED TERMINALLY ILL CEDAR CREEK MANOR I (611026) CATHERINE A FOSICK Type: CBRF HCBS COMPLIANT (715) 355-8751 Class: CNA 2480 TERREBONNE DRIVE ADVANCED AGED MOSINEE WI 54455 CATHERINE FOSICK Gender - Capacity: M/F - 16 (715) 355-8246 LINDA FOSICK 2480 TERREBONNE DRIVE Low/High rate: 3,218/4,716 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON MOSINEE WI 54455 Initial License: 01/29/1998 PHYSICALLY DISABLED CEDAR CREEK MANOR II (0009074) CATHERINE FOSICK Type: CBRF HCBS COMPLIANT (715) 355-8751 Class: CNA 2482 TERREBONNE DRIVE ADVANCED AGED MOSINEE WI 54455 CATHERINE FOSICK Gender - Capacity: M/F - 16 (715) 241-8807 LINDA FOSICK 2480 TERREBONNE DRIVE Low/High rate: 3,402/4,926 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON MOSINEE WI 54455 Initial License: 09/01/2000 PHYSICALLY DISABLED PUBLIC FUNDING CEDAR RIDGE ELDER SERVICES I (0011516) CEDAR RIDGE ELDER SERVICES LLC Type: CBRF HCBS COMPLIANT (715) 432-2811 Class: CNA 4930 ALDERSON STREET ADVANCED AGED SCHOFIELD WI 54476 PAULA ROBAZEK Gender - Capacity: M/F - 14 (715) 359-1913 PAULA ROBAZEK 2309 ROSS AVENUE Low/High rate: 1,645/4,699 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON SCHOFIELD WI 54476 Initial License: 06/06/2006 PHYSICALLY DISABLED TERMINALLY ILL CEDAR RIDGE ELDER SERVICES II (0011517) CEDAR RIDGE ELDER SERVICES LLC Type: CBRF HCBS COMPLIANT (715) 432-2811 Class: CNA 4932 ALDERSON STREET ADVANCED AGED SCHOFIELD WI 54476 PAULA ROBAZEK Gender - Capacity: M/F - 14 (715) 359-4838 PAULA ROBAZEK 2309 ROSS AVENUE Low/High rate: 1,646/4,699 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON SCHOFIELD WI 54476 Initial License: 06/06/2006 PHYSICALLY DISABLED TERMINALLY ILL CEDAR RIDGE ELDER SERVICES III (0011519) CEDAR RIDGE ELDER SERVICES LLC Type: CBRF HCBS COMPLIANT (715) 432-2811 Class: CS 2309 ROSS AVENUE ADVANCED AGED SCHOFIELD WI 54476 PAULA ROBAZEK Gender - Capacity: M/F - 11 (715) 355-6170 PAULA ROBAZEK 2309 ROSS AVENUE Low/High rate: 1,646/4,699 DEVELOPMENTALLY DISABLED County: MARATHON SCHOFIELD WI 54476 Initial License: 06/06/2006 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 68 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CEDAR RIDGE ELDER SERVICES IV (0011518) CEDAR RIDGE ELDER SERVICES LLC Type: CBRF HCBS COMPLIANT (715) 432-2811 Class: CNA 385 ORBITING DRIVE ADVANCED AGED MOSINEE WI 54455 PAULA ROBAZEK Gender - Capacity: M/F - 16 (715) 693-7024 PAULA ROBAZEK 2309 ROSS AVENUE Low/High rate: 1,646/4,699 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON SCHOFIELD WI 54476 Initial License: 06/06/2006 PHYSICALLY DISABLED TERMINALLY ILL CHADWICK STREET COMMUNITY RESIDENCE (610254) NORTH CENTRAL HEALTH CARE Type: CBRF HCBS COMPLIANT (715) 848-4403 Class: CNA 5006 CHADWICK STREET DEVELOPMENTALLY DISABLED SCHOFIELD WI 54476 TONI KELLNER Gender - Capacity: M/F - 8 (715) 355-7759 JAMIE COLLINS 1100 LAKEVIEW DRIVE Low/High rate: 4,470/6,060 PHYSICALLY DISABLED County: MARATHON WAUSAU WI 54403 Initial License: 10/12/1994 CLARITY CARE FERN (0018277) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 3013 MANN STREET ADVANCED AGED MARSHFIELD WI 54449 BARB SALEMI Gender - Capacity: M/F - 8 (920) 236-6560 KIM HANSEN 424 WASHINGTON AVENUE Low/High rate: 4,440/5,538 DEVELOPMENTALLY DISABLED County: MARATHON OSHKOSH WI 54901 Initial License: 02/17/2021 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY CLARITY CARE VILLA (0018276) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 3017 MANN STREET ADVANCED AGED MARSHFIELD WI 54449 BARB SALEMI Gender - Capacity: M/F - 8 (920) 236-6560 CASSANDRA MABREY 424 WASHINGTON AVENUE Low/High rate: 4,440/5,938 DEVELOPMENTALLY DISABLED County: MARATHON OSHKOSH WI 54901 Initial License: 02/17/2021 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY COPPERLEAF ASSISTED LIVING OF MARATHON (0015799 COPPERLEAF MANAGEMENT GROUP INC Type: CBRF HCBS COMPLIANT (715) 254-4357 Class: CNA 663 MARATECH AVENUE ADVANCED AGED MARATHON CITY WI 54448 KRISTA MENDYKE Gender - Capacity: M/F - 25 (715) 443-2727 DIANE BASINA 1077 WILSHIRE BLVD Low/High rate: 4,350/6,350 EMOTIONALLY DISTURBED/MENTAL County: MARATHON STEVENS POINT WI 54481 Initial License: 09/01/2015 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL COPPERLEAF ASSISTED LIVING OF SCHOFIELD (0015800 COPPERLEAF MANAGEMENT GROUP, INC Type: CBRF HCBS COMPLIANT (715) 498-1678 Class: CNA 1408 LILI LANE ADVANCED AGED SCHOFIELD WI 54476 KRISTA MENDYKE Gender - Capacity: M/F - 25 (715) 298-0218 DIANE BASINA 1077 WILSHIRE BLVD Low/High rate: 4,350/6,350 EMOTIONALLY DISTURBED/MENTAL County: MARATHON STEVENS POINT WI 54481 Initial License: 09/01/2015 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL COPPERLEAF MEMORY CARE OF SCHOFIELD (0015798) COPPERLEAF MANAGEMENT GROUP, INC Type: CBRF HCBS COMPLIANT (715) 498-1678 Class: CNA 1404 LILI LANE ADVANCED AGED SCHOFIELD WI 54476 KRISTA MENDYKE Gender - Capacity: M/F - 22 (715) 355-0586 DIANE BASINA 1077 WILSHIRE BLVD Low/High rate: 4,350/6,350 EMOTIONALLY DISTURBED/MENTAL County: MARATHON STEVENS POINT WI 54481 Initial License: 09/01/2015 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL COUNTRY TERRACE STRATFORD (0015590) COUNTRY TERRACE OF WISCONSIN Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 213721 LEGION ST ADVANCED AGED STRATFORD WI 54484 JASON LINDEMANN Gender - Capacity: M/F - 15 (715) 687-4786 MICHELLE KRAMER PO BOX 3006 Low/High rate: 3,100/4,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON OSHKOSH WI 54903 Initial License: 06/01/2015 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 69 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HEATHER STREET COMMUNITY RESIDENCE (610246) NORTH CENTRAL HEALTH CARE Type: CBRF HCBS COMPLIANT (715) 848-4403 Class: CNA 5010 HEATHER STREET DEVELOPMENTALLY DISABLED SCHOFIELD WI 54476 TONI KELLNER Gender - Capacity: M/F - 7 (715) 359-4815 CHERYL ZEINERT 1100 LAKEVIEW DRIVE Low/High rate: 3,990/6,060 PHYSICALLY DISABLED County: MARATHON WAUSAU WI 54403 Initial License: 09/12/1994 MOUNTAIN TERRACE SENIOR LIVING CBRF (0015628) TERRACE COURT SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (715) 843-5230 Class: CNA 3402 TERRACE COURT ADVANCED AGED WAUSAU WI 54401 LEE JOHNSON Gender - Capacity: M/F - 35 (715) 843-5230 KIMBERLY SPURGEON 1675 E RIVERSIDE DR STE 150 Low/High rate: 1,780/5,950 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON EAGLE ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL NORTH CENTRAL HEALTH CARE (0017915) NORTH CENTRAL HEALTH CARE Type: CBRF ALCOHOL/DRUG DEPENDENT 1100 LAKEVIEW DRIVE (715) 848-4405 Class: CS WAUSAU WI 54403 LAURA SCUDIERE Gender - Capacity: M/F - 14 (715) 848-4405 MICHAEL LOY 1100 LAKEVIEW DRIVE Low/High rate: 7,500/9,000 County: MARATHON WAUSAU WI 54403 Initial License: 01/02/2020 NORTH CENTRAL HEALTH CARE CRISIS CBRF (0018428) NORTH CENTRAL HEALTH CARE Type: CBRF HCBS COMPLIANT (715) 848-4600 Class: AS 1100 LAKE VIEW DRIVE EMOTIONALLY DISTURBED/MENTAL WAUSAU WI 54403 TRISHA STEFONEK Gender - Capacity: M/F - 16 (715) 848-4489 MICHAEL STEFONEK 1100 LAKE VIEW DRIVE Low/High rate: 10,800/36,936 County: MARATHON WAUSAU WI 54403 Initial License: 05/07/2021 OUR HOUSE WAUSAU ASSISTED CARE (0013424) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT () - Class: CNA 210 W CAMPUS DR ADVANCED AGED WAUSAU WI 54401 LORI NARDIN Gender - Capacity: M/F - 20 (715) 675-4444 HANNAH KOSTNER 4350 156TH STREET Low/High rate: 3,575/3,775 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING OUR HOUSE WAUSAU MEMORY CARE (0013422) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 220 W CAMPUS DR ADVANCED AGED WAUSAU WI 54401 LORI NARDIN Gender - Capacity: M/F - 20 (715) 675-4440 HANNAH KOSTNER 4350 156TH STREET Low/High rate: 4,450/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING PRIDE TLC THERAPY AND LIVING CAMPUS (0014504) FIRST PHOENIX-WESTON LLC Type: CBRF ADVANCED AGED (715) 298-3833 Class: CNA 7805 BIRCH ST IRREVERSIBLE DEMENTIA/ALZHEIM WESTON WI 54476 SALLY CONWAY Gender - Capacity: M/F - 60 (715) 298-4284 SALLY CONWAY 7805 BIRCH ST Low/High rate: 3,995/6,500 PHYSICALLY DISABLED County: MARATHON WESTON WI 54476 Initial License: 03/15/2013 PUBLIC FUNDING TERMINALLY ILL PRIMROSE MEMORY CARE OF WAUSAU (0016736) WAUSAU MEMORY CARE LLC Type: CBRF ADVANCED AGED (605) 226-3300 Class: CNA 7704 FRANCISCAN WAY IRREVERSIBLE DEMENTIA/ALZHEIM WESTON WI 54476 MARK MCNEARY Gender - Capacity: M/F - 32 (715) 842-1818 GEOFF POPLAWSKI PO BOX 1359 Low/High rate: 5,795/7,945 TERMINALLY ILL County: MARATHON ABERDEEN SD 57402-1359 Initial License: 10/11/2017 SPRING CREST (0018300) BROWNS LIVING LLC Type: CBRF HCBS COMPLIANT (715) 650-3304 Class: CNA 5601 SHERMAN STREET DEVELOPMENTALLY DISABLED WAUSAU WI 54401 DAVID THEWES Gender - Capacity: M/F - 8 (715) 298-3101 DAVID THEWES 252 S CENTRAL AVE STE 21 Low/High rate: 14,729/17,794 EMOTIONALLY DISTURBED/MENTAL County: MARATHON MARSHFIELD WI 54449 Initial License: 02/11/2021 TRAUMATIC BRAIN INJURY STEVES HOME (610201) STEVE TEWES Type: CBRF HCBS COMPLIANT (999) 999-9999 Class: AA 309 BELLIS STREET DEVELOPMENTALLY DISABLED WAUSAU WI 54403 STEVE TEWES Gender - Capacity: M - 6 (999) 999-9999 STEVE TEWES 309 BELLIS STREET Low/High rate: 1,619/4,562 County: MARATHON WAUSAU WI 54403 Initial License: 06/09/1993 STONE CREST RESIDENCE (0009226) HOMME INC OF WISCONSIN Type: CBRF HCBS COMPLIANT (715) 845-1214 Class: CNA 805 PARCHER STREET ADVANCED AGED WAUSAU WI 54403 AMY FORST Gender - Capacity: M/F - 16 (715) 849-9563 AMY FORST 2901 NORTH 7TH STREET Low/High rate: 5,378/5,378 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON WAUSAU WI 54403 Initial License: 02/13/2001 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 70 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SUNSHINE HOME OF WAUSAU (0013924) KATHRYN BUDIMLIJA Type: CBRF HCBS COMPLIANT (425) 299-2135 Class: AA 719 WASHINGTON ST ADVANCED AGED WAUSAU WI 54403 KATHRYN BUDIMLIJA Gender - Capacity: M/F - 8 (715) 848-8868 KATHRYN BUDIMLIJA 132458 COTTAGE RD Low/High rate: 2,027/3,790 DEVELOPMENTALLY DISABLED County: MARATHON MOSINEE WI 54455 Initial License: 02/06/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING SYLVAN CROSSINGS ON EVERGREEN (0008655) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 277-8887 Class: CNA 1605 EVERGREEN ROAD ADVANCED AGED WAUSAU WI 54403 DANIEL FLEMING Gender - Capacity: M/F - 21 (715) 675-3827 JODI KNISPEL 2960 TRIVERTON PIKE Low/High rate: 4,120/5,150 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON MADISON WI 53711 Initial License: 07/01/1999 PHYSICALLY DISABLED TERMINALLY ILL SYLVAN CROSSINGS ON EVERGREEN (0008655) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 277-8887 Class: CNA 1605 EVERGREEN ROAD ADVANCED AGED WAUSAU WI 54403 DANIEL FLEMING Gender - Capacity: M/F - 21 (715) 675-3827 JODI KNISPEL 2960 TRIVERTON PIKE Low/High rate: 4,120/5,150 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON MADISON WI 53711 Initial License: 07/01/1999 PHYSICALLY DISABLED TERMINALLY ILL WATERFORD AT COLBY (THE) (0015955) CSL COLBY LLC Type: CBRF HCBS COMPLIANT (972) 308-8387 Class: CNA 1110 N DIVISION STREET ADVANCED AGED COLBY WI 54421 KIRSTEN HUTCHISON Gender - Capacity: M/F - 48 (715) 223-2200 KIRSTEN HUTCHISON 1740 CONDOR LANE Low/High rate: 2,800/4,580 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON GREEN BAY WI 54313 Initial License: 01/26/2016 PHYSICALLY DISABLED TERMINALLY ILL WELLINGTON PLACE AT RIB MOUNTAIN (0018302) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (303) 980-0611 Class: CNA 149500 COUNTY ROAD NN ADVANCED AGED WAUSAU WI 54401 BARBARA BOENSKI Gender - Capacity: M/F - 30 (715) 842-5000 BARBARA BOENSKI 149500 COUNTY ROAD NN Low/High rate: 2,704/4,840 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARATHON WAUSAU WI 54401 Initial License: 11/18/2020 PHYSICALLY DISABLED WILLOW HAVEN CBRF LLC (0012930) MARGARET/DANIEL BUDIMLIJA Type: CBRF HCBS COMPLIANT (715) 321-3733 Class: CNA 804 12TH STREET ADVANCED AGED MOSINEE WI 54455 MARGARET/DANIEL BUDIMLIJA Gender - Capacity: M/F - 10 (715) 693-8233 MARGARET BUDIMLIJA 133227 FISHERMAN COV Low/High rate: 2,677/5,290 DEVELOPMENTALLY DISABLED County: MARATHON MOSINEE WI 54455 Initial License: 04/15/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING ANTHONY HOUSE (0010562) MARNIETTE CO GROUP HOME ASSOCIATION IN Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 735-5818 Class: ANA 900 WELLS ST CORRECTIONAL CLIENTS MARINETTE WI 54143 PAMELA LOSINSKI Gender - Capacity: M/F - 12 (715) 735-5818 PAMELA LOSINSKI 900 WELLS ST Low/High rate: 2,044/2,263 EMOTIONALLY DISTURBED/MENTAL County: MARINETTE MARINETTE WI 54143 Initial License: 05/12/2004 PUBLIC FUNDING ARBOR VILLAGE INC (0016677) ARBOR VILLAGE INC Type: CBRF ADVANCED AGED (715) 801-0388 Class: CNA 620 HARPER AVE DEVELOPMENTALLY DISABLED PESHTIGO WI 54157 NANCY KAFURA Gender - Capacity: M/F - 50 (715) 801-0388 NANCY KAFURA 620 HARPER AVE Low/High rate: 3,500/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARINETTE PESHTIGO WI 54157 Initial License: 11/22/2017 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL COTTAGES AT LAKE PARK (THE) (0017939) COTTAGES AT LAKE PARK LLC (THE) Type: CBRF HCBS COMPLIANT (920) 848-3458 Class: CNA 2006 LAKE PARK DRIVE ADVANCED AGED MARINETTE WI 54143 CARA PETERSON Gender - Capacity: M/F - 35 (920) 284-1749 CARA PETERSON 751 EAST HIGHLAND DRIVE Low/High rate: 4,890/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARINETTE OCONTO FALLS WI 54154 Initial License: 12/05/2019 EDGEWOOD MANOR (410026) NORTHLAND LUTHERAN RETIREMENT COMM Type: CBRF HCBS COMPLIANT (715) 732-0155 Class: AA 1101 NORTHLAND TERRACE LN DEVELOPMENTALLY DISABLED MARINETTE WI 54143 DARRELL T LANCOUR Gender - Capacity: M/F - 8 (715) 735-7447 DARREL LANCOUR 831 PINE BEACH ROAD Low/High rate: 2,100/2,498 PUBLIC FUNDING County: MARINETTE MARINETTE WI 54143 Initial License: 05/01/1987

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 71 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LUTHER MANOR (0008721) NORTHLAND LUTHERAN SERVICES FOR THE EL Type: CBRF ADVANCED AGED (715) 732-0155 Class: CNA 831 PINE BEACH ROAD IRREVERSIBLE DEMENTIA/ALZHEIM MARINETTE WI 54143 DARRELL LANCOUR Gender - Capacity: M/F - 55 (715) 732-0155 DARRELL LANCOUR 831 PINE BEACH ROAD Low/High rate: 2,722/6,950 PUBLIC FUNDING County: MARINETTE MARINETTE WI 54143 Initial License: 09/28/1999 TERMINALLY ILL Association Approval: LeadingAge Wisconsin NEWCARE RESIDENCE (0015057) NEWCARE INC Type: CBRF ADVANCED AGED (715) 854-2717 Class: CNA 903 MAIN AVE IRREVERSIBLE DEMENTIA/ALZHEIM CRIVITZ WI 54114 SHARON SWANSON Gender - Capacity: M/F - 26 (715) 854-7474 SHARON SWANSON PO BOX 460 Low/High rate: 2,899/3,869 PHYSICALLY DISABLED County: MARINETTE CRIVITZ WI 54114 Initial License: 05/14/2014 PUBLIC FUNDING REM WISCONSIN II INC SHORE DRIVE (0012909) REM WISCONSIN II INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA N2511 SHORE DR ADVANCED AGED MARINETTE WI 54143 LORI WRIGHT Gender - Capacity: M/F - 6 (715) 732-0615 DeAnna Dertz 4033 123rd ST, STE A Low/High rate: 6,120/13,901 DEVELOPMENTALLY DISABLED County: MARINETTE CHIPPEWA FALLS WI 54729 Initial License: 09/01/2009 PHYSICALLY DISABLED PUBLIC FUNDING SV NORTH MARINETTE NORTH (0017755) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 875 UNIVERSITY DR ADVANCED AGED MARINETTE WI 54143 JEFFREY SEEGMILLER Gender - Capacity: M/F - 15 (715) 732-1772 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 2,600/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARINETTE WITTENBERG WI 54499 Initial License: 10/01/2019 PHYSICALLY DISABLED TERMINALLY ILL SV NORTH MARINETTE SOUTH (0017759) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 3206 WOODLAND RD ADVANCED AGED MARINETTE WI 54143 JEFFREY SEEGMILLER Gender - Capacity: M/F - 15 (715) 732-1772 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 2,600/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARINETTE WITTENBERG WI 54499 Initial License: 10/01/2019 PHYSICALLY DISABLED TERMINALLY ILL GOLDEN YEARS INC BLDG 1 (0012736) THOMAS JAMES BOWMAN Type: CBRF HCBS COMPLIANT (608) 697-0991 Class: CNA 497 SOUTH LAKE STREET ADVANCED AGED MONTELLO WI 53949 THOMAS BOWMAN Gender - Capacity: M/F - 8 (608) 297-9883 DANYEL BOWMAN PO BOX 705 Low/High rate: 3,100/6,000 DEVELOPMENTALLY DISABLED County: MARQUETTE PACKWAUKEE WI 53953 Initial License: 03/19/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY GOLDEN YEARS INC BLDG 2 (0012700) THOMAS JAMES BOWMAN Type: CBRF HCBS COMPLIANT (608) 697-0991 Class: CNA 497 SOUTH LAKE STREET ADVANCED AGED MONTELLO WI 53949 THOMAS BOWMAN Gender - Capacity: M/F - 8 (608) 297-7999 DANYEL BOWMAN PO BOX 705 Low/High rate: 3,100/6,000 DEVELOPMENTALLY DISABLED County: MARQUETTE PACKWAUKEE WI 53953 Initial License: 03/19/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY HARRIS VILLA INC (0011562) HARRIS VILLA INC Type: CBRF HCBS COMPLIANT (608) 296-3190 Class: CNA N6581 VILLA PARK WAY ADVANCED AGED WESTFIELD WI 53964 NANETTE HINZE Gender - Capacity: M/F - 33 (608) 296-3190 NANETTE HINZE N6581 VILLA PARK WAY Low/High rate: 2,900/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARQUETTE WESTFIELD WI 53964 Initial License: 09/08/2006 PHYSICALLY DISABLED TERMINALLY ILL WAIVER CERTIFIED INDEPENDENT C

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 72 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MILL POND ONE (0013473) LAKEVIEW CARE PARTNERS INC Type: CBRF HCBS COMPLIANT (608) 296-4195 Class: CNA 507 S MARKER ST ALCOHOL/DRUG DEPENDENT WESTFIELD WI 53964 ANDY OLIVARES Gender - Capacity: M/F - 8 (262) 534-7297 ANDY OLIVARES 507 S MARKET ST Low/High rate: 5,131/23,573 DEVELOPMENTALLY DISABLED County: MARQUETTE WESTFIELD WI 53964 Initial License: 11/01/2010 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY MILL POND TWO (0013474) LAKEVIEW CARE PARTNERS INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 296-4195 Class: CNA 515 S MARKET ST DEVELOPMENTALLY DISABLED WESTFIELD WI 53964 ANDY OLIVARES Gender - Capacity: M/F - 8 (262) 534-7297 ANDY OLIVARES 507 MARKET ST Low/High rate: 5,131/23,573 EMOTIONALLY DISTURBED/MENTAL County: MARQUETTE WESTFIELD WI 53964 Initial License: 11/01/2010 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY OUR HOUSE II (0009454) OUR HOUSE I II III LLC Type: CBRF HCBS COMPLIANT (920) 293-4663 Class: CS N9211 CTY RD N ADVANCED AGED NESHKORO WI 54960 SCOTT LANGER Gender - Capacity: M/F - 8 (920) 293-8509 SCOTT LANGER N9211 CTY RD N Low/High rate: 2,700/5,100 DEVELOPMENTALLY DISABLED County: MARQUETTE NESHKORO WI 54960 Initial License: 10/01/2001 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED RESIDENCES ON FOREST LANE (THE) (0012609) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (303) 980-0611 Class: CNA 253 FOREST LANE ADVANCED AGED MONTELLO WI 53949 KATHLEEN SCHLOTE Gender - Capacity: M/F - 16 (608) 297-8240 KATHLEEN SCHLOTE 253 FOREST LN Low/High rate: 2,875/4,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARQUETTE MONTELLO WI 53949 Initial License: 12/23/2008 PHYSICALLY DISABLED RESIDENCES ON FOREST LANE (THE) (0012609) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (303) 980-0611 Class: CNA 253 FOREST LANE ADVANCED AGED MONTELLO WI 53949 KATHLEEN SCHLOTE Gender - Capacity: M/F - 16 (608) 297-8240 KATHLEEN SCHLOTE 253 FOREST LN Low/High rate: 2,875/4,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARQUETTE MONTELLO WI 53949 Initial License: 12/23/2008 PHYSICALLY DISABLED RESIDENCES ON FOREST LANE (THE) (0012609) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (303) 980-0611 Class: CNA 253 FOREST LANE ADVANCED AGED MONTELLO WI 53949 KATHLEEN SCHLOTE Gender - Capacity: M/F - 16 (608) 297-8240 KATHLEEN SCHLOTE 253 FOREST LN Low/High rate: 2,875/4,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: MARQUETTE MONTELLO WI 53949 Initial License: 12/23/2008 PHYSICALLY DISABLED 2ND CENTURY (0013598) MATT TALBOT RECOVERY SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 342-5474 Class: AA 2187 S 85TH ST PUBLIC FUNDING WEST ALLIS WI 53227 KARL RAJANI Gender - Capacity: F - 8 (414) 321-5936 ANTONIO DESHAZOR P O BOX 20007 Low/High rate: 3,285/4,250 County: MILWAUKEE GREENFIELD WI 53220 Initial License: 02/11/2011 A NURTURING HOME AWAY FROM HOME INC (0015887) MARY MITCHELL Type: CBRF ADVANCED AGED (414) 870-2207 Class: ANA 8225B N 107TH ST ALCOHOL/DRUG DEPENDENT MILWAUKEE WI 53224 MARY MITCHELL Gender - Capacity: M/F - 8 (414) 870-2207 LISA NETTERVILLE 8225B N 107TH ST Low/High rate: 4,000/5,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 01/23/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY A PLACE FOR MIRACLES LIVING CENTER (0009870) A PLACE FOR MIRACLES LIVING CENTER INC Type: CBRF HCBS COMPLIANT (414) 788-3068 Class: CNA 5100 N 42ND ST ADVANCED AGED MILWAUKEE WI 53209 TONI HOWARD Gender - Capacity: M/F - 6 (414) 438-9433 TONI HOWARD PO BOX 242196 Low/High rate: 2,400/5,550 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 06/09/2003 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 73 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

A PLACE FOR MIRACLES LIVING CENTER II (0011085) A PLACE FOR MIRACLES LIVING CENTER INC Type: CBRF HCBS COMPLIANT (414) 788-3068 Class: CA 7022 N 43RD ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53209 TONI HOWARD Gender - Capacity: M/F - 7 (414) 438-9433 TONI HOWARD PO BOX 242196 Low/High rate: 2,415/3,500 County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 03/30/2006 A PLACE FOR MIRACLES LIVING CENTER II (0011085) A PLACE FOR MIRACLES LIVING CENTER INC Type: CBRF HCBS COMPLIANT (414) 788-3068 Class: CA 7022 N 43RD ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53209 TONI HOWARD Gender - Capacity: M/F - 7 (414) 438-9433 TONI HOWARD PO BOX 242196 Low/High rate: 2,415/3,500 County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 03/30/2006 Association Approval: WALA A PLACE FOR MIRACLES LIVING CENTER III (0011885) A PLACE FOR MIRACLES LIVING CENTER III LLC Type: CBRF HCBS COMPLIANT (414) 788-3068 Class: CA 3927 W ROOSEVELT DR ADVANCED AGED MILWAUKEE WI 53216 TONI HOWARD Gender - Capacity: M/F - 6 (414) 444-0234 TONI HOWARD PO BOX 242196 Low/High rate: 2,700/3,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 05/01/2007 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING ABBYHAVEN (310658) GOLDEN CARE INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CS 4865 S 95TH ST ADVANCED AGED GREENFIELD WI 53228 DAN HOECHERL Gender - Capacity: M/F - 8 (414) 427-5432 DAN HOECHERL 4405 S DEERWOOD DR Low/High rate: 3,278/3,278 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151 Initial License: 10/09/1997 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED ALEXIAN VILLAGE OF MILWAUKEE COURTYARD (310150) ALEXIAN VILLAGE OF MILWAUKEE INC Type: CBRF HCBS COMPLIANT (414) 355-9300 Class: CNA 9301 N 76TH ST ADVANCED AGED MILWAUKEE WI 53223 CARRIE HENSEL Gender - Capacity: M/F - 29 (414) 355-9300 CARRIE HENSEL 9301 N 76TH ST Low/High rate: 5,800/8,350 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MILWAUKEE WI 53223 Initial License: 12/01/1991 PUBLIC FUNDING Association Approval: WALA ALEXIAN VILLAGE SQUARE (0008627) ALEXIAN VILLAGE OF MILWAUKEE INC Type: CBRF ADVANCED AGED (414) 355-9300 Class: CNA 9301 N 76TH ST IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53223 CARRIE HENSEL Gender - Capacity: M/F - 64 (414) 355-9300 CARRIE HENSEL 9301 N 76TH ST Low/High rate: 5,481/7,810 PUBLIC FUNDING County: MILWAUKEE MILWAUKEE WI 53223 Initial License: 07/22/1999 Association Approval: WALA AMEIRA ORCHIDS ASSISTED LIVING (0018396) CACHE JAMES BETTER LIVING LLC Type: CBRF ADVANCED AGED (414) 852-0938 Class: CNA 10401 WEST BRADLEY ROAD IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53224 ATIYAH NICHOLS Gender - Capacity: M/F - 25 (414) 852-0938 ATIYAH NICHOLS PO BOX 248 Low/High rate: 3,295/4,595 PHYSICALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53223 Initial License: 06/03/2021 TERMINALLY ILL ANCHORAGE HOMES II (0012095) L & L ANCHORAGE HOMES Type: CBRF HCBS COMPLIANT (414) 871-4272 Class: AS 3843 N 51ST BLVD ADVANCED AGED MILWAUKEE WI 53216 LUREAN SLOCUM Gender - Capacity: M/F - 7 (414) 445-7449 LUREAN SLOCUM 5340 W MELVINA ST Low/High rate: 2,750/3,415 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53216 Initial License: 05/01/2008 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING ANGELS HEARTH (0013961) BRYANT HOMES LLC Type: CBRF HCBS COMPLIANT (414) 241-7067 Class: CNA 3468 S 119TH ST ADVANCED AGED WEST ALLIS WI 53227 CANDACE DAHLKE Gender - Capacity: M/F - 8 (414) 727-0822 CANDACE DAHLKE 12501 W NEEDHAM DR Low/High rate: 0/3,333 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53132 Initial License: 01/01/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 74 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ARGONNE (0011364) DUNGARVIN WISCONSIN LLC Type: CBRF HCBS COMPLIANT (414) 443-1311 Class: CNA 9835 W ARGONNE DR DEVELOPMENTALLY DISABLED WAUWATOSA WI 53222 VALERIE HARMAN Gender - Capacity: F - 5 (414) 755-6840 MICHAEL LEO 10425 W NORTH AVE SUITE 330 Low/High rate: 393,957/5,832 PUBLIC FUNDING County: MILWAUKEE WAUWATOSA WI 53226 Initial License: 03/31/2006 ARIA WEST ALLIS (0018335) ARIA AT MITCHELL MANOR Type: CBRF ADVANCED AGED (847) 983-4860 Class: CNA 5301 W LINCOLN AVE IRREVERSIBLE DEMENTIA/ALZHEIM WEST ALLIS WI 53219 NETANEL BRANDMAN Gender - Capacity: M/F - 70 (414) 615-7100 SARAH STIB 8150 CENTRAL PARK Low/High rate: 150 TERMINALLY ILL County: MILWAUKEE SKOKIE IL 60076 Initial License: 12/17/2020 ARMSTEAD VENTURES LLC (0018235) ARMSTEAD VENTURES LLC Type: CBRF HCBS COMPLIANT (414) 839-8721 Class: AA 2877 NORTH 53RD STREET ADVANCED AGED MILWAUKEE WI 53210 ANGELINA HOWARD Gender - Capacity: M/F - 5 (414) 839-8721 ANGELINA HOWARD 2877 NORTH 53RD STREET Low/High rate: 3,500/15,000 ALCOHOL/DRUG DEPENDENT County: MILWAUKEE MILWAUKEE WI 53210 Initial License: 09/24/2020 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED AT HOME LIVING (0018108) AT HOME LIVING Type: CBRF HCBS COMPLIANT (414) 406-3294 Class: AA 2339 NORTH 60TH STREET ADVANCED AGED WAUWATOSA WI 53210 APRIL JUETT Gender - Capacity: M/F - 8 (414) 406-3294 APRIL JUETT PO BOX 785 Low/High rate: 3,100/4,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUWATOSA WI 53052 Initial License: 06/18/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM TRAUMATIC BRAIN INJURY AUTUMN CREEK CQS LLC (0014863) AUTUMN CREEK CQS, LLC Type: CBRF HCBS COMPLIANT (414) 397-4176 Class: CS 8035 S CECILY DRIVE ADVANCED AGED OAK CREEK WI 53154 BRIAN SCHOENLEBER Gender - Capacity: M/F - 8 BRIAN SCHOENLEBER 8035 S CECILY DRIVE Low/High rate: 2,900/3,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE OAK CREEK WI 53154 Initial License: 12/18/2013 IRREVERSIBLE DEMENTIA/ALZHEIM AUTUMN CREEK II CQS LLC (0016326) AUTUMN CREEK II CQS LLC Type: CBRF ADVANCED AGED (414) 397-4176 Class: ANA 1326 WILLOW DR DEVELOPMENTALLY DISABLED OAK CREEK WI 53154 MICHAEL QUARTANA Gender - Capacity: M/F - 20 (414) 397-4176 BRIAN SCHOENLEBER 1326 W WILLOW DR Low/High rate: EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE OAK CREEK WI 53154 Initial License: 10/13/2016 PHYSICALLY DISABLED AUTUMN OAKES (0015228) AUTUMN OAKES INC Type: CBRF HCBS COMPLIANT (262) 498-3098 Class: CNA 1110 W OAKWOOD RD ADVANCED AGED OAK CREEK WI 53154 BETH DESAI Gender - Capacity: M/F - 8 (414) 766-0915 BETH DESAI 1110 W OAKWOOD RD Low/High rate: 3,400/3,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE OAK CREEK WI 53154 Initial License: 09/22/2014 PUBLIC FUNDING AZURA MEMORY CARE OF OAK CREEK (0016675) AZURA OAK CREEK LLC Type: CBRF HCBS COMPLIANT (303) 909-4081 Class: CNA 8772 S MAYHEW DR ADVANCED AGED OAK CREEK WI 53154 JILL KREIDER Gender - Capacity: M/F - 24 EGRISELDA TUJANI 1233 MAYFAIR RD STE 301 Low/High rate: 4,950/9,075 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MILWAUKEE WI 53226 Initial License: 07/27/2017 AZURA MEMORY CARE OF OAK CREEK II (0016676) AZURA OAK CREEK II LLC Type: CBRF HCBS COMPLIANT (303) 909-4081 Class: CNA 8774 S MAYHEW DR ADVANCED AGED OAK CREEK WI 53154 JILL KREIDER Gender - Capacity: M/F - 24 EGRISELDA TUJANI 1233 MAYFAIR RD STE 301 Low/High rate: 4,600/8,550 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MILWAUKEE WI 53226 Initial License: 09/20/2017 BARNETT HOUSE (0015010) MCFI dba WHOLE HEALTH CLINICAL GROUP Type: CBRF HCBS COMPLIANT (414) 459-3014 Class: AA 2466 N 50TH STREET EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53210 JORDAN FARNAND Gender - Capacity: M - 12 (414) 459-3014 JORDAN FARNAND 932 S 60TH STREET Low/High rate: 3,537/3,537 County: MILWAUKEE MILWAUKEE WI 53214 Initial License: 08/07/2014 Association Approval: WALA

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 75 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BAYSIDE GROUP HOME (0018245) SABER GROUP HOMES Type: CBRF HCBS COMPLIANT (414) 214-8207 Class: CS 8820 N REXLEIGH DR ADVANCED AGED BAYSIDE WI 53217 SARA IZGELOV Gender - Capacity: M/F - 8 (414) 514-8207 SARA IZGELOV 3240 N 52ND ST Low/High rate: 2,500/8,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53216 Initial License: 12/01/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL BELL THERAPY BELWOOD (0010783) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: CS 5151 W SILVER SPRING DR DEVELOPMENTALLY DISABLED MILWAUKEE WI 53218-3300 JESSICA ZOCH Gender - Capacity: M/F - 46 (414) 527-6970 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 5,082/5,626 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53218-3300 Initial License: 09/22/2005 PUBLIC FUNDING BELL THERAPY BELWOOD VIII MARTIN CBRF (310134) PHOENIX CARE SYSTEMS INC Type: CBRF EMOTIONALLY DISTURBED/MENTAL 1141 N 46TH ST (414) 527-6970 Class: AA MILWAUKEE WI 53208 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 51ST BLVD Low/High rate: 3,104/3,104 County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 06/10/1991 BELL THERAPY BLUEMOUND (310038) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 101 N 75TH ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53213 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 3,100/4,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 11/01/1984 BELL THERAPY CHAMBERS (310079) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 6328 W CHAMBERS ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53210 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 3,109/3,968 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53218-3300 Initial License: 01/01/1988 BELL THERAPY CONGRESS (310059) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 6333 W CONGRESS ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53218 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51 ST BLVD Low/High rate: 2,704/3,844 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53218-3300 Initial License: 10/31/1984 BELL THERAPY FLORIST (0009565) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 7401 W FLORIST AVE ADVANCED AGED MILWAUKEE WI 53218 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51st Blvd Low/High rate: 4,115/4,556 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53218-3300 Initial License: 04/23/2002 EMOTIONALLY DISTURBED/MENTAL BELL THERAPY HAMPTON (310104) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: CA 4901 N 106TH ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53225 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 4,300/4,300 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 11/21/1988 BELL THERAPY KEEFE (310295) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 6105 W KEEFE AVE PKWY ADVANCED AGED MILWAUKEE WI 53216 JULIA WARZYNSKI Gender - Capacity: M/F - 6 (414) 447-7566 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 4,570/5,882 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53218-3300 Initial License: 03/31/1996 EMOTIONALLY DISTURBED/MENTAL BELL THERAPY KIEHNAU (0011199) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: CA 10133 10135 W KIEHNAU AVE DEVELOPMENTALLY DISABLED MILWAUKEE WI 53224 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51 ST BLVD Low/High rate: 5,009/5,009 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 12/12/2005 BELL THERAPY SILVERLAWN (0012049) PHOENIX CARE SYSTEMS INC Type: CBRF DEVELOPMENTALLY DISABLED (414) 527-6970 Class: AA 5554-5556 N 57TH ST EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53218 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 2,908/2,908 County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 10/01/2005

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 76 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BELL THERAPY THURSTON (0008680) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 5734 N 94TH ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53225 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 11,599/12,399 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 08/06/1999 BELL THERAPY UNDERWOOD (0009082) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 3146 E UNDERWOOD AVE EMOTIONALLY DISTURBED/MENTAL CUDAHY WI 53110 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 4,747/5,256 PUBLIC FUNDING County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 09/15/2000 BERGEN MANOR CBRF (0017968) BERGEN MANOR LLC Type: CBRF HCBS COMPLIANT (414) 745-3053 Class: CNA 522 WEST BERGEN DRIVE ADVANCED AGED FOX POINT WI 53217 MICHAEL ROGINSKIY Gender - Capacity: M/F - 8 (888) 484-7566 MICHAEL ROGINSKIY PO BOX 242444 Low/High rate: 3,500/7,000 ALCOHOL/DRUG DEPENDENT County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 01/23/2020 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BREATH OF LIFE RESIDENCE (0012232) LATRESHA A ROBINSON RN Type: CBRF HCBS COMPLIANT (414) 736-9775 Class: CS 4072-4074 N 64TH ST ADVANCED AGED MILWAUKEE WI 53216-0000 LATRESHA A ROBINSON RN Gender - Capacity: M/F - 7 (414) 461-9378 LATRESHA A ROBINSON RN 4074 N 64TH STREET Low/High rate: 3,500/4,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53216 Initial License: 02/22/2008 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY BRENWOOD PARK ASSISTED LIVING (0015615) BRENWOOD PARK SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (414) 448-0800 Class: CNA 9535 W LOOMIS RD ADVANCED AGED FRANKLIN WI 53132 LEE JOHNSON Gender - Capacity: M/F - 50 (262) 255-2557 JEANIE BROGNI 1675 E Riverside Dr.SUite 150 Low/High rate: 2,097/4,895 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE Eagle ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL BRIGHT CARE (0017574) BRIGHT CARE LLC Type: CBRF HCBS COMPLIANT (630) 202-2539 Class: CNA 9035 N 97TH ST ADVANCED AGED MILWAUKEE WI 53224 TAOUFIK TONY LAHRACHE Gender - Capacity: M/F - 28 (414) 368-3311 TAOUFIK TONY LAHRACHE 1617 DOVER DRIVE UNIT 14 Low/High rate: 3,700/5,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53186 Initial License: 08/01/2019 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED BROTOLOC FRANKLIN (0013104) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (414) 423-9904 Class: ANA 9460 S 46TH ST ADVANCED AGED FRANKLIN WI 53132 CHRISTOPHER COHEN Gender - Capacity: M/F - 6 (414) 423-9904 JESSIE OBERHOFER 209 S TAFT ST Low/High rate: 4,563/9,125 DEVELOPMENTALLY DISABLED County: MILWAUKEE WHITEWATER WI 53190 Initial License: 02/05/2010 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY BROTOLOC GREENFIELD (0013102) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: ANA 3826 S 36TH ST ADVANCED AGED GREENFIELD WI 53221 CHRISTOPHER COHEN Gender - Capacity: M/F - 7 (414) 325-0741 Jessie Oberhofer 209 S TAFT ST Low/High rate: 4,563/9,125 DEVELOPMENTALLY DISABLED County: MILWAUKEE WHITEWATER WI 53190 Initial License: 02/05/2010 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 77 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BROTOLOC GREENFIELD (0013102) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: ANA 3826 S 36TH ST ADVANCED AGED GREENFIELD WI 53221 CHRISTOPHER COHEN Gender - Capacity: M/F - 7 (414) 325-0741 Jessie Oberhofer 209 S TAFT ST Low/High rate: 4,563/9,125 DEVELOPMENTALLY DISABLED County: MILWAUKEE WHITEWATER WI 53190 Initial License: 02/05/2010 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY BROTOLOC WEST ALLIS (0013103) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: AA 2355 S 68TH ST ADVANCED AGED WEST ALLIS WI 53219 CHRISTOPHER COHEN Gender - Capacity: M/F - 6 (414) 329-8403 Jessie Oberhofer 209 S TAFT ST Low/High rate: 4,563/9,125 DEVELOPMENTALLY DISABLED County: MILWAUKEE WHITEWATER WI 53190 Initial License: 02/05/2010 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING TRAUMATIC BRAIN INJURY BROTOLOC WEST ALLIS (0013103) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: AA 2355 S 68TH ST ADVANCED AGED WEST ALLIS WI 53219 CHRISTOPHER COHEN Gender - Capacity: M/F - 6 (414) 329-8403 Jessie Oberhofer 209 S TAFT ST Low/High rate: 4,563/9,125 DEVELOPMENTALLY DISABLED County: MILWAUKEE WHITEWATER WI 53190 Initial License: 02/05/2010 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING TRAUMATIC BRAIN INJURY BURLEIGH HOUSE (0015155) MCFI dba WHOLE HEALTH CLINICAL GROUP Type: CBRF HCBS COMPLIANT (414) 459-3014 Class: AA 8221 W BURLEIGH STREET EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53222 JORDAN FARNAND Gender - Capacity: F - 8 (414) 459-3014 JORDAN FARNAND 932 S 60TH STREET Low/High rate: 4,429/4,429 County: MILWAUKEE MILWAUKEE WI 53214 Initial License: 07/28/2014 Association Approval: WALA CAMBRIDGE CASTLE (0015544) CASTLE SENIOR LIVING, INC. Type: CBRF ADVANCED AGED (414) 427-1655 Class: CNA 3531 W GRANGE AVENUE ALCOHOL/DRUG DEPENDENT MILWAUKEE WI 53221 MICHELLE GREEN Gender - Capacity: M/F - 8 (414) 930-4328 MICHELLE GREEN 13050 W Cleveland Ave Low/High rate: 4,500/6,200 DEVELOPMENTALLY DISABLED County: MILWAUKEE New Berlin WI 53151 Initial License: 08/26/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA CAMELOT CASTLE (0015518) Castle Senior Living Inc Type: CBRF HCBS COMPLIANT (414) 427-1655 Class: CS 4900 S 68th Street ADVANCED AGED Greenfield WI 53220 Kristopher Kiefer Gender - Capacity: M/F - 8 (414) 817-9188 MICHELLE GREEN 4900 S 68th Street Low/High rate: 3,800/5,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE Greenfield WI 53220 Initial License: 02/19/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CASTLE RIDGE (0015523) Castle Senior Living Inc Type: CBRF HCBS COMPLIANT (414) 427-1655 Class: CNA 10133 Brookside Drive ADVANCED AGED Hales Corners WI 53130 DIANA HOWELL Gender - Capacity: M/F - 8 (414) 427-9344 DIANA HOWELL 13050 W CLEVELAND AVE Low/High rate: 4,200/5,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151 Initial License: 02/19/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 78 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CCLS - BRADLEY (310090) CREATIVE COMMUNITY LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: CNA 8010 N 51ST ST DEVELOPMENTALLY DISABLED BROWN DEER WI 53223 JIM ZACHE Gender - Capacity: M/F - 6 (414) 355-1432 RICHARD CZERWAN 314 E MAIN ST Low/High rate: 1,861/5,433 PUBLIC FUNDING County: MILWAUKEE WATERTOWN WI 53094 Initial License: 01/31/1982 Association Approval: DSPN CHAI POINT ASSISTED LIVING (310190) PROSPECT CONGREGATE HOUSING INC Type: CBRF ADVANCED AGED (414) 289-9600 Class: CNA 1400 N PROSPECT AVE PUBLIC FUNDING MILWAUKEE WI 53202 TRISH COHN Gender - Capacity: M/F - 38 (414) 289-9600 TRISH COHN 1400 N PROSPECT AVE Low/High rate: 4,849/5,334 County: MILWAUKEE MILWAUKEE WI 53202 Initial License: 03/28/1994 Association Approval: LeadingAge Wisconsin CLEMENT MANOR INC (0016468) CLEMENT MANOR INC Type: CBRF ADVANCED AGED (414) 321-1800 Class: CNA 3939 S 92ND STREET IRREVERSIBLE DEMENTIA/ALZHEIM GREENFIELD WI 53228 DENNIS FERGER Gender - Capacity: M/F - 47 (414) 321-1800 THOMAS SCHULZ 3939 S 92ND STREET Low/High rate: 5,000/6,000 County: MILWAUKEE GREENFIELD WI 53228 Initial License: 04/06/2017 Association Approval: LeadingAge Wisconsin CLIFDEN COURT EAST (0016973) SHA MSL GREENDALE LLC Type: CBRF ADVANCED AGED (312) 623-0884 Class: CNA 6751 S 68TH ST IRREVERSIBLE DEMENTIA/ALZHEIM FRANKLIN WI 53132 THOMAS OSTROM Gender - Capacity: M/F - 24 (414) 858-7000 ROTH WEAVER 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/8,000 PHYSICALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 04/19/2018 TERMINALLY ILL CLIFDEN COURT NORTH (0016972) SHA MSL GREENDALE LLC Type: CBRF ADVANCED AGED (312) 623-0884 Class: CNA 6801 W LOOMIS RD IRREVERSIBLE DEMENTIA/ALZHEIM GREENDALE WI 53129 THOMAS OSTROM Gender - Capacity: M/F - 68 (414) 858-0700 CAROLYN JOHNSON 101 NORTH WACKER DRIVE STE 616 Low/High rate: 3,000/8,000 PHYSICALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 04/19/2018 TERMINALLY ILL CLIFDEN COURT WEST (0016974) SHA MSL GREENDALE LLC Type: CBRF ADVANCED AGED (312) 623-0884 Class: CNA 6771 S 68TH ST IRREVERSIBLE DEMENTIA/ALZHEIM FRANKLIN WI 53132 THOMAS OSTROM Gender - Capacity: M/F - 33 (414) 858-7000 ROTH WEAVER 101 NORTH WACKER DRIVE STE 616 Low/High rate: 3,000/8,000 PHYSICALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 04/19/2018 TERMINALLY ILL CLOSE TO HOME SENIOR LIVING - BLUEMOUND HOME (0 CLOSE TO HOME SENIOR LIVING FACILITIES LLC Type: CBRF ADVANCED AGED (708) 790-0546 Class: CNA 12231 W BLUEMOUND ROAD DEVELOPMENTALLY DISABLED WAUWATOSA WI 53226 JOVE CASTILLO Gender - Capacity: M/F - 20 (414) 302-9400 JOVE CASTILLO 12231 W BLUEMOUND ROAD Low/High rate: 3,100/5,700 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE WAUWATOSA WI 53226 Initial License: 01/18/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CLOSE TO HOME SENIOR LIVING - GRANTOSA HOME (00 CLOSE TO HOME SENIOR LIVING FACILITIES LLC Type: CBRF ADVANCED AGED (708) 790-0546 Class: CS 4265 N 104TH STREET DEVELOPMENTALLY DISABLED MILWAUKEE WI 53222 JOVE CASTILLO Gender - Capacity: M/F - 20 (414) 461-2300 JOVE CASTILLO 4265 N 104TH STREET Low/High rate: 3,100/5,700 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53222 Initial License: 01/18/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CONGRESS PLACE (0013291) ABSOLUTE HOME CARE LLC Type: CBRF HCBS COMPLIANT (414) 745-3053 Class: ANA 9025 W CONGRESS ST ADVANCED AGED MILWAUKEE WI 53225 MICHAEL ROGINSKIY Gender - Capacity: M/F - 8 (414) 745-3053 LUCAS SANDERS P O BOX 242444 Low/High rate: 2,950/6,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 09/28/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 79 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

COUNTRY VIEW (0011567) GOLDEN OAK CREST LLC Type: CBRF HCBS COMPLIANT (414) 764-3303 Class: CNA 10507 S CHICAGO AVE ADVANCED AGED OAK CREEK WI 53154 JOHN TERESINSKI Gender - Capacity: M/F - 50 (414) 764-3303 TARA HUSEMANN 2448 S 102nd St Suite 305 Low/High rate: 3,000/4,600 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE West Allis WI 53045 Initial License: 08/29/2006 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING CREATIVE LIVING ENVIRONMENTS - BAYSIDE (0015802) CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF ADVANCED AGED (920) 261-1345 Class: CNA 225 E BROWN DEER RD EMOTIONALLY DISTURBED/MENTAL BAYSIDE WI 53217 JIM ZACHE Gender - Capacity: M/F - 20 (414) 540-2324 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,496/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE WATERTOWN WI 53094 Initial License: 10/19/2015 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL CREATIVE LIVING ENVIRONMENTS - BAYSIDE (0015802) CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF ADVANCED AGED (920) 261-1345 Class: CNA 225 E BROWN DEER RD EMOTIONALLY DISTURBED/MENTAL BAYSIDE WI 53217 JIM ZACHE Gender - Capacity: M/F - 20 (414) 540-2324 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,496/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE WATERTOWN WI 53094 Initial License: 10/19/2015 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL CREATIVE LIVING ENVIRONMENTS - BAYSIDE (0015802) CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF ADVANCED AGED (920) 261-1345 Class: CNA 225 E BROWN DEER RD EMOTIONALLY DISTURBED/MENTAL BAYSIDE WI 53217 JIM ZACHE Gender - Capacity: M/F - 20 (414) 540-2324 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,496/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE WATERTOWN WI 53094 Initial License: 10/19/2015 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: WADSA CREATIVE LIVING ENVIRONMENTS LAYTON COURT (001 CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 12320 W LAYTON AVE ADVANCED AGED GREENFIELD WI 53228 KATHRYN BERGEN Gender - Capacity: M/F - 8 (414) 425-8777 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,037/3,400 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE WATERTOWN WI 53094 Initial License: 10/10/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CREATIVE LIVING ENVIRONMENTS LAYTON COURT (001 CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 12320 W LAYTON AVE ADVANCED AGED GREENFIELD WI 53228 KATHRYN BERGEN Gender - Capacity: M/F - 8 (414) 425-8777 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,037/3,400 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE WATERTOWN WI 53094 Initial License: 10/10/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CREATIVE LIVING ENVIRONMENTS LAYTON COURT (001 CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 12320 W LAYTON AVE ADVANCED AGED GREENFIELD WI 53228 KATHRYN BERGEN Gender - Capacity: M/F - 8 (414) 425-8777 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,037/3,400 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE WATERTOWN WI 53094 Initial License: 10/10/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: DSPN CREEK SIDE TERRACE (0013958) CARING ALTERNATIVES LLC Type: CBRF HCBS COMPLIANT (414) 305-9533 Class: CNA 8861 S 13TH ST ADVANCED AGED OAK CREEK WI 53154 WENDY SIEVERT Gender - Capacity: M/F - 29 (414) 856-9300 WENDY SIEVERT P.O. BOX 308 Low/High rate: 3,400/6,450 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE OAK CREEK WI 53154 Initial License: 12/12/2011 Association Approval: WALA CRISIS RESOURCE CENTER (0015203) MCFI dba WHOLE HEALTH CLINICAL GROUP Type: CBRF HCBS COMPLIANT (414) 459-3014 Class: AA 2057 S 14TH STREET EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53204 DAN BAKER Gender - Capacity: M/F - 15 (414) 449-9891 DAN BAKER 2057 S 14TH STREET Low/High rate: 5,952/13,687 PUBLIC FUNDING County: MILWAUKEE MILWAUKEE WI 53204 Initial License: 11/06/2014 *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 80 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CRU GROUP HOME INC BROWN DEER MANOR (0012325 CRU GROUP HOME INC Type: CBRF HCBS COMPLIANT (414) 247-1726 Class: CNA 8238 N 44TH ST ADVANCED AGED BROWN DEER WI 53209 GALINA DONETS Gender - Capacity: M/F - 8 (414) 247-1426 GALINA DONETS 1125 LAKE COOK ROAD Low/High rate: 3,500/4,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE NORTHBROOK IL 60062 Initial License: 05/22/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CUDAHY PLACE (0016798) CUDAHY PLACE SENIOR LIVING LLC Type: CBRF ADVANCED AGED (312) 462-4462 Class: CNA 3460 E BARNARD AVE IRREVERSIBLE DEMENTIA/ALZHEIM CUDAHY WI 53110 THOMAS OSTROM Gender - Capacity: M/F - 48 (414) 258-9955 MEREDITH HUMPHREY 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/7,000 PHYSICALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 03/01/2019 TERMINALLY ILL DEWEY CENTER OF AURORA PSYCHIATRIC HOSPITAL (0 AURORA PSYCHIATRIC HOSPITAL Type: CBRF ALCOHOL/DRUG DEPENDENT 1220 DEWEY AVE 11 (414) 454-6473 Class: AS WAUWATOSA WI 53213 PETE CARLSON Gender - Capacity: M/F - 30 (414) 454-6576 PETE CARLSON 1220 DEWEY AVE 11 Low/High rate: 3,900/18,500 County: MILWAUKEE WAUWATOSA WI 53213 Initial License: 07/23/2018 DUNGARVIN WI N 87TH (0013957) DUNGARVIN WISCONSIN LLC Type: CBRF HCBS COMPLIANT (414) 443-1311 Class: CNA 4501 N 87TH ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53225 VALERIE HARMAN Gender - Capacity: M/F - 7 (414) 462-3839 MICHAEL LEO 10425 W NORTH AVE STE 330 Low/High rate: 23,991/23,991 PHYSICALLY DISABLED County: MILWAUKEE WAUWATOSA WI 53226 Initial License: 04/03/2012 PUBLIC FUNDING EASTCASTLE PLACE (0011864) EASTCASTLE PLACE Type: CBRF ADVANCED AGED (414) 963-6151 Class: CNA 2429 E BRADFORD AVE IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53211 TYLER GUDEX Gender - Capacity: M/F - 18 (414) 963-6151 TYLER GUDEX 2429 E BRADFORD AVE Low/High rate: 5,964/6,603 County: MILWAUKEE MILWAUKEE WI 53211 Initial License: 06/14/2007 Association Approval: LeadingAge Wisconsin ELIZABETH RESIDENCE NORTH (0009330) ELIZABETH RESIDENCE INC Type: CBRF HCBS COMPLIANT (414) 540-4141 Class: CNA 9329 S 48TH ST ADVANCED AGED FRANKLIN WI 53132 RICHARD COURY Gender - Capacity: M/F - 33 (414) 421-4324 RICHARD COURY 6340 N GREEN BAY AVE Low/High rate: 3,437/7,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE GLENDALE WI 53209 Initial License: 07/12/2001 Association Approval: WALA ELIZABETH RESIDENCE OAK CREEK (0013620) RICHARD F COURY Type: CBRF HCBS COMPLIANT (414) 540-4141 Class: CNA 10441 S NICHOLSON RD ADVANCED AGED OAK CREEK WI 53154 RICHARD COURY Gender - Capacity: M/F - 20 (414) 762-5118 RICHARD COURY 6340 N GREEN BAY AVE Low/High rate: 4,000/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE GLENDALE WI 53209 Initial License: 03/16/2011 ELIZABETH RESIDENCE OF BAYSIDE (0010952) RJJG LLC Type: CBRF HCBS COMPLIANT (414) 352-4663 Class: CNA 9289 N PORT WASHINGTON RD ADVANCED AGED BAYSIDE WI 53217 AARON CHARAPATA Gender - Capacity: M/F - 56 (414) 352-4663 AARON CHARAPATA 9289 N PORT WASHINGTON RD Low/High rate: 5,700/7,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE BAYSIDE WI 53217 Initial License: 06/09/2005 PUBLIC FUNDING EMERALD CASTLE (0015520) Castle Senior Living Inc Type: CBRF HCBS COMPLIANT (414) 427-1655 Class: CNA 11125 W Layton Avenue ADVANCED AGED Greenfield WI 53228 Kristopher Kiefer Gender - Capacity: M/F - 8 (414) 427-0027 MICHELLE GREEN 11125 W Layton Avenue Low/High rate: 3,800/5,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE Greenfield WI 53228 Initial License: 02/19/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA ESSENCE LIVING CARE (0018531) ESSENCE LIVING CARE Type: CBRF HCBS COMPLIANT (407) 738-2992 Class: AA 2617 NORTH 54TH STREET ADVANCED AGED MILWAUKEE WI 53210 GUSTAVO COLMENARES Gender - Capacity: M/F - 7 (407) 738-2992 NICOLE BILLINGLEA 600 FALCON DRIVE APT 604 Low/High rate: 6,500/9,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE ABSECON NJ 08201 Initial License: 07/13/2021 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 81 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ESTHERMERE MANOR (0012625) THE ESTHER HOUSE INC Type: CBRF HCBS COMPLIANT (414) 334-1225 Class: CNA 7000 N 44TH ST ADVANCED AGED MILWAUKEE WI 53223 DEBORAH CROWLEY Gender - Capacity: M/F - 5 (414) 334-1225 DEBORAH CROWLEY PO BOX 91387 Low/High rate: 3,934/4,210 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53209 Initial License: 03/31/2009 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY EVERLASTING CARE ADULT FAMILY HOMES (0017874) EVERLASTING CARE ADULT FAMILY HOMES Type: CBRF HCBS COMPLIANT (414) 350-9274 Class: ANA 6329 W THURSTON AVE ADVANCED AGED MILWAUKEE WI 53218 Demetria McDowell Gender - Capacity: M/F - 5 (414) 350-9274 CRYSTAL SULLIVAN PO BOX 90841 Low/High rate: 5,000/15,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53209 Initial License: 01/30/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY FARDALE HOME (0017606) WILLOWBROOK SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (217) 553-3065 Class: CS 3031 W FARDALE AVE ADVANCED AGED MILWAUKEE WI 53221 KUROSH DEJGOSHA Gender - Capacity: M/F - 20 (414) 944-9314 DEJGOSHA KUROSH 1345 N JEFFERSON ST STE 328 Low/High rate: 3,000/6,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53202 Initial License: 05/01/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING Association Approval: WALA FINCH HOUSE (0012715) MILOUDI INC Type: CBRF HCBS COMPLIANT (262) 271-0993 Class: CNA 5762 FINCH LN ADVANCED AGED GREENDALE WI 53129 SAM HASSAN LAHRACHE Gender - Capacity: M/F - 8 (414) 421-5592 RAKESH PATEL W274 S4025 TIMBER TRAIL Low/High rate: 3,180/3,450 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53189 Initial License: 07/01/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING FOX POINT MANOR (0009113) GALINA DONETS Type: CBRF ADVANCED AGED (414) 351-5430 Class: CS 7450 N PORT WASHINGTON RD DEVELOPMENTALLY DISABLED FOX POINT WI 53217 GALINA DONETS Gender - Capacity: M/F - 8 (414) 228-1490 GALINA DONETS 1125 LAKE COOK ROAD Low/High rate: 3,100/3,600 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE NORTHBROOK IL 60062 Initial License: 12/14/2000 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING FOXCROFT CROSSING (0013959) BRYANT HOMES LLC Type: CBRF HCBS COMPLIANT (414) 241-7067 Class: CNA 7220 FOXCROFT CT ADVANCED AGED FRANKLIN WI 53132 CANDACE DAHLKE Gender - Capacity: M/F - 8 (414) 858-9091 CANDACE DAHLKE 12501 W NEEDHAM DR Low/High rate: 0/3,790 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151 Initial License: 01/01/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA FRANCISCAN GARDENS (0016782) CHI LIVING COMMUNITIES Type: CBRF HCBS COMPLIANT (419) 357-2877 Class: CNA 1000 WILLIAMS AVE IRREVERSIBLE DEMENTIA/ALZHEIM SOUTH MILWAUKEE WI 53172 MIKE GULOCK Gender - Capacity: M/F - 60 (414) 764-4100 MIKE GULOCK 1000 WILLIAMS AVE Low/High rate: 6,000/6,309 PUBLIC FUNDING County: MILWAUKEE SOUTH MILWAUKEE WI 53172 Initial License: 08/14/2017 Association Approval: LeadingAge Wisconsin FRANKLIN HOUSE (0015898) MATT TALBOT RECOVERY SERVICES INC Type: CBRF EMOTIONALLY DISTURBED/MENTAL (414) 342-5474 Class: CNA 9132 SOUTH 92ND STREET PUBLIC FUNDING FRANKLIN WI 53132 KARL RAJANI Gender - Capacity: M/F - 8 (414) 367-2336 ANTONEO DESHAZOR PO BOX 20007 Low/High rate: 600/18,000 County: MILWAUKEE GREENFIELD WI 53220-0007 Initial License: 03/24/2016

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 82 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

GOLDEN GARDENS (0012911) GARDEN VIEW PLATINUM LLC Type: CBRF HCBS COMPLIANT (414) 940-3134 Class: CNA 8526 W MILL RD ADVANCED AGED MILWAUKEE WI 53225 JOHN TERESINSKI Gender - Capacity: M/F - 38 (414) 940-6608 PAULA GASTON 2448 S 102nd Street Suite305 Low/High rate: 2,800/3,700 DEVELOPMENTALLY DISABLED County: MILWAUKEE West Allis WI 53227 Initial License: 01/27/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL GOLDEN VIEW (0011359) GOLDEN VIEW LLC Type: CBRF HCBS COMPLIANT (262) 989-5382 Class: CNA 6526 W BLUEMOUND RD ADVANCED AGED MILWAUKEE WI 53213 MARY FILLER Gender - Capacity: M/F - 33 (262) 939-5297 ANNE-MARIE FOGEL 19913 SPRING STREET Low/High rate: 2,800/3,700 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE UNION GROVE WI 53182 Initial License: 03/06/2006 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING GRACEFUL LIVING CENTER INC (0012451) GRACEFUL LIVING CENTER INC Type: CBRF HCBS COMPLIANT (414) 975-2485 Class: AA 3628 N 41ST ST ADVANCED AGED MILWAUKEE WI 53216 ARDELIA SWIAMS Gender - Capacity: M/F - 8 (414) 442-5740 ARDELIA SWIAMS 3917 N 26TH ST Low/High rate: 2,750/3,750 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53206 Initial License: 09/17/2008 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING GREENFIELD HOUSE (0015031) MCFI dba WHOLE HEALTH CLINICAL GROUP Type: CBRF HCBS COMPLIANT (414) 459-3014 Class: AA 10521 W GREENFIELD AVENUE EMOTIONALLY DISTURBED/MENTAL WEST ALLIS WI 53214 JORDAN FARNAND Gender - Capacity: M/F - 8 (414) 459-3014 JORDAN FARNAND 932 S 60TH STREET Low/High rate: 4,048/4,048 County: MILWAUKEE MILWAUKEE WI 53214 Initial License: 08/07/2014 Association Approval: WALA HAMMOND HOUSE (0010416) INDEPENDENT LIFESTYLES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: AS 3750 E HAMMOND AVE ADVANCED AGED CUDAHY WI 53110 DAN HOECHERL Gender - Capacity: M/F - 18 (414) 486-4120 DAN HOECHERL 4405 E DEERWOOD DR Low/High rate: 2,881/2,881 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151-9240 Initial License: 11/19/2003 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED HAMPTON II (0014895) OMEGA COMMUNITY SERVICES, LLC Type: CBRF HCBS COMPLIANT (414) 380-2436 Class: AA 7019 W HAMPTON AVENUE DEVELOPMENTALLY DISABLED MILWAUKEE WI 53218 RACHEL OEMIG KLEIN Gender - Capacity: M/F - 6 (414) 578-1294 RACHEL OEMIG KLEIN 7019 W HAMPTON AVENUE Low/High rate: 3,183/10,254 PUBLIC FUNDING County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 01/01/2014 HAMPTON SUPPORTIVE CARE (310631) WILLOW OF PARKVIEW INC Type: CBRF ADVANCED AGED (414) 466-6427 Class: CNA 4615 W HAMPTON AVE CORRECTIONAL CLIENTS MILWAUKEE WI 53218 SAMUEL BRANDMAN Gender - Capacity: M/F - 36 (414) 466-6427 SHARON BUTLER 2711 W HOWARD ST Low/High rate: 3,300/3,800 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE CHICAGO IL 60645-1303 Initial License: 12/02/1996 PHYSICALLY DISABLED PUBLIC FUNDING HANDS AT HOME CBRF (0018273) HANDS AT HOME LLC Type: CBRF ADVANCED AGED (414) 349-4280 Class: AA 6401-6403 NORTH 42ND STREET DEVELOPMENTALLY DISABLED MILWAUKEE WI 53209 CLARINDRIA ADDISON Gender - Capacity: M/F - 6 (414) 236-5860 CLARINDRIA ADDISON 6825 W BROWN DEER RD 242302 Low/High rate: 4,500/7,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 07/19/2021 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY HARBORCHASE OF SHOREWOOD (0015906) CHP SHOREWOOD WI TENANT CORP Type: CBRF HCBS COMPLIANT (407) 650-1000 Class: CNA 1111 E CAPITOL DR ADVANCED AGED SHOREWOOD WI 53211 KEN KEALEY Gender - Capacity: M/F - 41 (414) 436-0311 KEN KEALEY 1111 E CAPITOL DR Low/High rate: 5,795/7,495 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE SHOREWOOD WI 53211 Initial License: 12/08/2015 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 83 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HARBORCHASE OF SHOREWOOD (0015906) CHP SHOREWOOD WI TENANT CORP Type: CBRF HCBS COMPLIANT (407) 650-1000 Class: CNA 1111 E CAPITOL DR ADVANCED AGED SHOREWOOD WI 53211 KEN KEALEY Gender - Capacity: M/F - 41 (414) 436-0311 KEN KEALEY 1111 E CAPITOL DR Low/High rate: 5,795/7,495 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE SHOREWOOD WI 53211 Initial License: 12/08/2015 PUBLIC FUNDING HARBOUR ASSISTED LIVING RESIDENCES (0017872) LCS GREENDALE LLC Type: CBRF ADVANCED AGED 5800 MOCKINGBIRD LN (615) 394-2187 Class: CNA GREENDALE WI 53129 DEBRA BARTH Gender - Capacity: M/F - 48 (414) 421-9600 DEBRA BARTH 5800 MOCKINGBIRD LN Low/High rate: 5,415/6,273 County: MILWAUKEE GREENDALE WI 53129 Initial License: 10/01/2019 HARBOUR VILLAGE (0017825) LCS GREENDALE LLC Type: CBRF HCBS COMPLIANT (615) 394-2187 Class: CNA 5900 MOCKINGBIRD LN IRREVERSIBLE DEMENTIA/ALZHEIM GREENDALE WI 53129 DEBRA BARTH Gender - Capacity: M/F - 52 (414) 421-9600 DEBRA BARTH 5700 MOCKINGBIRD LN Low/High rate: 1,626/6,684 PUBLIC FUNDING County: MILWAUKEE GREENDALE WI 53129 Initial License: 10/01/2019 HARWOOD PLACE ASSISTED LIVING (0009947) HARWOOD PLACE INC Type: CBRF ADVANCED AGED (414) 256-6800 Class: CNA 8220 W HARWOOD AVE PHYSICALLY DISABLED WAUWATOSA WI 53213 SHERI POLCZYNSKI Gender - Capacity: M/F - 32 (414) 256-6837 SHERI POLCZYNSKI 8220 W HARWOOD AVE Low/High rate: 5,300/7,600 TERMINALLY ILL County: MILWAUKEE WAUWATOSA WI 53213 Initial License: 08/04/2003 Association Approval: LeadingAge Wisconsin HEARTIS VILLAGE NORTH SHORE (0017670) HEARTIS NORTH SHORE PARTNERS LP Type: CBRF ADVANCED AGED (214) 916-5750 Class: CNA 100 W RIVER WOODS PKWY IRREVERSIBLE DEMENTIA/ALZHEIM GLENDALE WI 53212 JULIE TICCIONI Gender - Capacity: M/F - 110 (414) 409-6700 Julie Ticcioni 100 W RIVER WOODS PKWY Low/High rate: 4,070/7,100 County: MILWAUKEE GLENDALE WI 53212 Initial License: 06/27/2019 HERITAGE WEST ALLIS HERITAGE 7 LLC (0012725) MILO PINKERTON Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA 7801 W NATIONAL AVE IRREVERSIBLE DEMENTIA/ALZHEIM WEST ALLIS WI 53214 MILO PINKERTON Gender - Capacity: M/F - 40 (414) 302-9705 AMANDA RUNNOE 7901 W NATIONAL AVE Low/High rate: 3,600/4,500 PUBLIC FUNDING County: MILWAUKEE WEST ALLIS WI 53214 Initial License: 10/21/2009 HERMAN HOUSE (0010082) HEALTHSPAN INC Type: CBRF HCBS COMPLIANT (414) 541-4700 Class: AA 3700 3702 S HERMAN ST ADVANCED AGED MILWAUKEE WI 53207 LORI PAPROCKI Gender - Capacity: M/F - 6 (414) 800-7927 HOLLY NYGRO 5520 W FOREST HOME AVE Low/High rate: 3,100/5,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE GREENFIELD WI 53220 Initial License: 05/01/2003 EMOTIONALLY DISTURBED/MENTAL TERMINALLY ILL HIDDEN TERRACE (0009379) LIFECARE HOMES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CS 3405 W SYCAMORE ADVANCED AGED FRANKLIN WI 53132 DAN HOECHERL Gender - Capacity: M/F - 8 (414) 423-5607 DAN HOECHERL 4405 S DEERWOOD DR Low/High rate: 3,680/3,680 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151-9240 Initial License: 08/01/2001 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED HIL SUNSET HOME (0011194) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 10212 W SUNSET AVE DEVELOPMENTALLY DISABLED WAUWATOSA WI 53222 LYNN MATZKE Gender - Capacity: M/F - 6 (414) 461-0140 KELLY THOMPSON 1249 RUSSETT COURT Low/High rate: 5,532/5,532 PHYSICALLY DISABLED County: MILWAUKEE GREEN BAY WI 54313 Initial License: 11/16/2005 PUBLIC FUNDING HIL WHITNALL HOUSE (0009798) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 6275 S 106TH ST DEVELOPMENTALLY DISABLED HALES CORNERS WI 53130 LYNN MATZKE Gender - Capacity: M/F - 6 (414) 427-4993 KELLY THOMPSON 1249 RUSSETT COURT Low/High rate: 7,107/7,107 PUBLIC FUNDING County: MILWAUKEE GREEN BAY WI 54313 Initial License: 01/01/2002 HILLCREST HOMES 44TH (310118) HILLCREST HOMES OF WEST ALLIS INC Type: CBRF HCBS COMPLIANT (414) 322-5437 Class: AS 5210 S 44TH ST DEVELOPMENTALLY DISABLED GREENFIELD WI 53220-5111 JOSEPH FUCHS Gender - Capacity: M/F - 8 (414) 423-8226 JOE FUCHS 12720 W LISBON RD Low/High rate: 1,875/2,010 County: MILWAUKEE BROOKFIELD WI 53005 Initial License: 09/15/1990

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 84 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HOMES OF HOPE LLC (0014586) HOMES OF HOPE LLC Type: CBRF HCBS COMPLIANT (414) 406-3294 Class: CNA 6609 NORTH 53RD STREET ADVANCED AGED MILWAUKEE WI 53224 APRIL JUETT Gender - Capacity: M/F - 5 (414) 406-3294 APRIL JUETT PO BOX 16177 Low/High rate: 3,875/5,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53216 Initial License: 08/02/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL INFINITY ASSISTED LIVING HOME (0015779) GOLDEN MILLENNIUM ENTERPRISES LLC Type: CBRF HCBS COMPLIANT (414) 803-3497 Class: CA 1665 SOUTH 64TH STREET ADVANCED AGED WEST ALLIS WI 53214 VITALIY GORELIK Gender - Capacity: M/F - 8 (414) 803-3497 VITALIY GORELIK 3701 W SHERBROOKE DR Low/High rate: 3,284/3,740 DEVELOPMENTALLY DISABLED County: MILWAUKEE MEQUON WI 53092 Initial License: 03/15/2016 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY IVY TERRACE (0014857) LIVE TO SERVE LLC Type: CBRF HCBS COMPLIANT (414) 762-5123 Class: AS 6606 S CRANE DRIVE ADVANCED AGED OAK CREEK WI 53154 DANIELLE MOREY Gender - Capacity: M/F - 8 (414) 762-5123 DANIELLE MOREY 8141 FOLEY RD Low/High rate: 3,400/3,600 DEVELOPMENTALLY DISABLED County: MILWAUKEE RACINE WI 53402 Initial License: 01/03/2014 JACKSON HOUSE (0015156) MCFI dba WHOLE CLINICAL HEALTH GROUP Type: CBRF HCBS COMPLIANT (414) 459-3014 Class: AS 2956 S 60TH ST EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53219 JORDAN FARNAND Gender - Capacity: M/F - 15 (414) 327-6374 JORDAN FARNAND 932 S 60TH ST Low/High rate: 4,979/4,979 County: MILWAUKEE MILWAUKEE WI 53214 Initial License: 07/28/2014 Association Approval: WALA JC VILLA ONE (0015286) D TAYLOR PROPERTIES LLC Type: CBRF HCBS COMPLIANT (414) 270-1970 Class: CNA 8030 W APPLETON AVE ADVANCED AGED MILWAUKEE WI 53218 DANIEL TAYLOR Gender - Capacity: M/F - 8 (414) 270-1970 DANIEL TAYLOR PO BOX 511325 Low/High rate: 3,300/4,300 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53203 Initial License: 12/08/2014 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA JC VILLA TWO (0015287) D TAYLOR PROPERTIES LLC Type: CBRF HCBS COMPLIANT (414) 688-7272 Class: CNA 8040 W APPLETON AVENUE ADVANCED AGED MILWAUKEE WI 53218 DANIEL TAYLOR Gender - Capacity: M/F - 8 (414) 270-1970 DANIEL TAYLOR PO BOX 511325 Low/High rate: 3,300/4,300 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53203 Initial License: 12/08/2014 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA JEANNETTA ROBINSON HOUSE (310701) GENESIS BEHAVIORAL SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 376-5445 Class: AA 5427 W VILLARD AVENUE PUBLIC FUNDING MILWAUKEE WI 53218 PATRICIA FAULHABER Gender - Capacity: M/F - 24 (414) 376-5445 PATRICIA FAULHABER 6737 W WASHINGTON ST #2210 Low/High rate: 2,615/2,950 County: MILWAUKEE WEST ALLIS WI 53214 Initial License: 10/31/1998

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 85 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

JEFFERSON CREST III YELLOW ROSE (0011678) D TAYLOR PROPERTIES Type: CBRF HCBS COMPLIANT (414) 688-7272 Class: CA 8717 W PALMETTO AVE ADVANCED AGED MILWAUKEE WI 53225 DANIEL TAYLOR Gender - Capacity: M/F - 5 (414) 270-1971 DANIEL TAYLOR P O BOX 511325 Low/High rate: 1,700/3,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53203 Initial License: 03/29/2007 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA JOSHUA GLOVER HOUSE (310186) WISCONSIN COMMUNITY SERVICES INC Type: CBRF CORRECTIONAL CLIENTS 2404 N 50TH ST (414) 271-2512 Class: AA MILWAUKEE WI 53210 CLARENCE JOHNSON Gender - Capacity: M - 36 (414) 442-3700 ARTIS LANDON 3732 W WISCONSIN AVE SUITE 200 Low/High rate: 2,112/2,640 County: MILWAUKEE MILWAUKEE WI 53208 Initial License: 02/14/1994 KINDREDHEARTS OF BROWN DEER (0009744) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 4015 W WOODALE AVE ADVANCED AGED BROWN DEER WI 53209 CATHY BAIRD Gender - Capacity: M/F - 16 (414) 355-7272 LATOYA LEE 4015 Woodale Ave. Low/High rate: 3,200/4,276 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE Brown Deer WI 53209 Initial License: 10/01/2002 PUBLIC FUNDING LAKE POINTE MANOR (310266) LIFECARE HOMES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CS 8781 TRAVIS CT ADVANCED AGED FRANKLIN WI 53132 DAN HOECHERL Gender - Capacity: M/F - 8 (414) 427-7707 DAN HOECHERL 4405 S DEERWOOD DR Low/High rate: 3,258/3,258 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151 Initial License: 06/12/1995 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED LAYTON TERRACE (0008596) LAYTON TERRACE V LLC Type: CBRF HCBS COMPLIANT (262) 548-5965 Class: CNA 9200 W LAYTON AVE ADVANCED AGED GREENFIELD WI 53228 BETH ANDERSON Gender - Capacity: M/F - 80 (414) 425-5600 TANYA OLSON 1805 KENSINGTON DR Low/High rate: 5,000/6,435 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE WAUKESHA WI 53188 Initial License: 08/27/1999 WAIVER CERTIFIED INDEPENDENT C LIFECARE MANOR (0008891) LIFECARE HOMES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CS 4013 S 119TH ST ADVANCED AGED GREENFIELD WI 53228 DAN HOECHERL Gender - Capacity: M/F - 8 (414) 545-6587 DAN HOECHERL 4405 E DEERWOOD DR Low/High rate: 3,258/3,258 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151-9240 Initial License: 02/10/2000 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED LINCOLN TERRACE GROUP HOME (0014399) GOLDEN MILLENNIUM ENTERPRISES LLC Type: CBRF HCBS COMPLIANT (414) 803-3497 Class: CS 2416 S 60TH ST ADVANCED AGED WEST ALLIS WI 53219 VITALIY GORELIK Gender - Capacity: M/F - 8 (414) 803-3497 VITALIY GORELIK 3701 SHERBROOKE DR Low/High rate: 3,284/3,740 DEVELOPMENTALLY DISABLED County: MILWAUKEE MEQUON WI 53092 Initial License: 12/07/2012 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING LUTHER MANOR COURTYARDS (310087) UNITED LUTHERAN PROGRAM FOR THE AGING Type: CBRF ADVANCED AGED (414) 464-3880 Class: CNA 4611 N 92ND ST IRREVERSIBLE DEMENTIA/ALZHEIM WAUWATOSA WI 53225 STEPHANIE CHEDID Gender - Capacity: M/F - 140 (414) 464-3880 ANGELA DOUGLAS 4545 N 92ND ST Low/High rate: 4,228/6,509 PUBLIC FUNDING County: MILWAUKEE WAUWATOSA WI 53225 Initial License: 11/27/1981 Association Approval: LeadingAge Wisconsin LYNX (0014191) DUNGARVIN WISCONSIN LLC Type: CBRF HCBS COMPLIANT (414) 443-1311 Class: CNA 6188 N 122ND ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53225 VALERIE HARMAN Gender - Capacity: M/F - 6 (414) 358-5071 MICHAEL LEO 10425 W NORTH AVE STE 330 Low/High rate: 32,905/32,905 PHYSICALLY DISABLED County: MILWAUKEE WAUWATOSA WI 53226 Initial License: 06/15/2012 PUBLIC FUNDING MAGNOLIA HOUSE (0017607) WILLOWBROOK SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (217) 553-3065 Class: CS 8919 N MICHELE ST ADVANCED AGED MILWAUKEE WI 53224 KUROSH DEJGOSHA Gender - Capacity: M/F - 20 (414) 446-9884 Kurosh Dejgosha 1345 N JEFFERSON ST STE 328 Low/High rate: 3,000/6,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53202 Initial License: 05/01/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 86 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs Association Approval: WALA MANITOBA GROUP HOME (0014252) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 3018 S 9TH ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53215 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51ST ST BLVD Low/High rate: EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 12/10/2012 MARANATHA HOUSE GLENDALE (THE) (0011513) AD2LUV LLC Type: CBRF HCBS COMPLIANT (414) 873-0515 Class: CS 4567 N 71ST STREET ADVANCED AGED MILWAUKEE WI 53218 UNDRAYE HOWARD Gender - Capacity: M/F - 8 (414) 464-0155 DEBORAH A CROWLEY W257 S5208 WOOD LILLY LANE Low/High rate: 3,058/3,850 ALCOHOL/DRUG DEPENDENT County: MILWAUKEE WAUKESHA WI 53189 Initial License: 01/07/2007 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY MARANATHA HOUSE POTOMAC (THE) (0016332) AD 2 LUV LLC Type: CBRF ADVANCED AGED (414) 617-8144 Class: CNA 7901 W POTOMAC AVE DEVELOPMENTALLY DISABLED MILWAUKEE WI 53222 UNDRAYE HOWARD Gender - Capacity: M/F - 8 (414) 210-5110 UNDRAYE HOWARD W257 S5208 WOOD LILLY LANE Low/High rate: 5,000/14,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE WAUKESHA WI 53189 Initial License: 02/02/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY MARANATHA HOUSE SOUTH (THE) (0012681) AD2LUV LLC Type: CBRF HCBS COMPLIANT (414) 873-0515 Class: CA 2526 S 85TH ST ADVANCED AGED WEST ALLIS WI 53227 UNDRAYE HOWARD Gender - Capacity: M/F - 6 (414) 543-0094 DEBORAH CROWLEY W257 S5208 WOOD LILLY LANE Low/High rate: 3,966/4,200 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53189 Initial License: 03/31/2009 EMOTIONALLY DISTURBED/MENTAL TRAUMATIC BRAIN INJURY MARANATHA HOUSE TACOMA (THE) (0012162) AD2LUV LLC Type: CBRF HCBS COMPLIANT (414) 873-0515 Class: CA 6811 N TACOMA ST ADVANCED AGED MILWAUKEE WI 53224-4748 UNDRAYE HOWARD Gender - Capacity: M/F - 5 (414) 446-8448 DEBORAH CROWLEY W257 S5208 WOOD LILLY LANE Low/High rate: 3,646/3,846 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53189 Initial License: 02/07/2008 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM TRAUMATIC BRAIN INJURY MATT TALBOT RECOVERY CENTER (310016) MATT TALBOT RECOVERY SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 342-5474 Class: AA 2613 W North Ave CORRECTIONAL CLIENTS MILWAUKEE WI 53205 Karl Rajani Gender - Capacity: M - 26 (414) 342-5474 ANTONIO DESHAZOR P O BOX 20007 Low/High rate: 3,240/4,860 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE GREENFIELD WI 53220 Initial License: 12/01/1986 PUBLIC FUNDING MATTHEWS OF MILWAUKEE I (0014182) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 7325 N PORT WASHINGTON RD ADVANCED AGED GLENDALE WI 53217-3416 THOMAS OSTROM Gender - Capacity: M/F - 20 (414) 540-0405 PAM CROFT 101 N WACKER DRIVE STE 616 Low/High rate: 4,020/7,040 DEVELOPMENTALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY MATTHEWS OF MILWAUKEE II (0014181) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 7335 N PORT WASHINGTON RD ADVANCED AGED GLENDALE WI 53217-3416 THOMAS OSTROM Gender - Capacity: M/F - 20 (414) 540-0242 PAM CROFT 101 N WACKER DRIVE STE 616 Low/High rate: 4,020/7,040 DEVELOPMENTALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 87 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MATTHEWS OF OAK CREEK (0014183) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 7550 S 13TH ST ADVANCED AGED OAK CREEK WI 53154 THOMAS OSTROM Gender - Capacity: M/F - 20 (414) 768-8889 MEREDITH HUMPHREY 101 N WACKER DRIVE STE 616 Low/High rate: 4,020/7,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY MATTHEWS OF SAINT FRANCIS I (0014180) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 3660 E DENTON AVE ADVANCED AGED ST FRANCIS WI 53235-5951 THOMAS OSTROM Gender - Capacity: M/F - 20 (414) 486-1008 ROBIN WADE 101 N WACKER DRIVE STE 616 Low/High rate: 4,020/7,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY MATTHEWS OF SAINT FRANCIS II (0014179) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 3620 E DENTON AVE ADVANCED AGED ST FRANCIS WI 53235-5951 THOMAS OSTROM Gender - Capacity: M/F - 20 (414) 744-2815 ROBIN WADE 101 N WACKER DRIVE STE 616 Low/High rate: 4,020/7,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY MERCY HILL LLC (0017663) MERCY HILL LLC Type: CBRF HCBS COMPLIANT (309) 368-1825 Class: CNA 11250 W COLDSPRING RD ADVANCED AGED GREENFIELD WI 53228 DANIELLE WESTCOMB Gender - Capacity: M/F - 8 (414) 427-7857 DANIELLE WESTCOMB 6801 BOBOLINK RD Low/High rate: 3,000/3,900 DEVELOPMENTALLY DISABLED County: MILWAUKEE RACINE WI 53402 Initial License: 08/14/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY META HOUSE (310697) META HOUSE INC Type: CBRF ALCOHOL/DRUG DEPENDENT 2618 N BREMEN ST (414) 962-1200 Class: AA MILWAUKEE WI 53212 CHRISTINE ULLSTRUP Gender - Capacity: M/F - 15 (414) 810-0705 CHRISTINE A ULLSTRUP 2625 N WEIL ST Low/High rate: 5,100/9,000 County: MILWAUKEE MILWAUKEE WI 53212 Initial License: 05/15/1998 META HOUSE RIVERWEST CAMPUS NORTH (310044) META HOUSE INC Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 962-1200 Class: AA 2626 N BREMEN ST PUBLIC FUNDING MILWAUKEE WI 53212 CHRISTINE ULLSTRUP Gender - Capacity: F - 20 (414) 962-1200 CHRISTINE ULLSTRUP 2625 N WEIL STREET Low/High rate: 5,100/9,000 County: MILWAUKEE MILWAUKEE WI 53212 Initial License: 04/01/1988 MIDLAND TERRACE (0008521) LIFECARE HOMES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CS 5128 W MIDLAND DR ADVANCED AGED GREENFIELD WI 53220 DAN HOECHERL Gender - Capacity: M/F - 8 (414) 545-0660 DAN HOECHERL 4405 S DEERWOOD DR Low/High rate: 3,279/3,279 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151 Initial License: 02/05/1999 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE CATHOLIC HOME (0014598) MILWAUKEE CATHOLIC HOME Type: CBRF ADVANCED AGED () - Class: CNA 2330 NORTH PROSPECT AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53211 PATRICK SHAUGHNESSY Gender - Capacity: M/F - 27 (414) 220-4610 THERESA OWENS 2330 NORTH PROSPECT AVENUE Low/High rate: 4,950/5,600 County: MILWAUKEE MILWAUKEE WI 53211 Initial License: 10/21/2014 Association Approval: LeadingAge Wisconsin MORE THAN A HOME CBRF (0017167) MORE THAN A HOME CBRF Type: CBRF DEVELOPMENTALLY DISABLED (414) 875-7496 Class: CNA 10135 WEST HAMPTON AVE EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53225 LYNELL MONNIE-NORTON Gender - Capacity: M/F - 8 (414) 585-9177 LYNELL MONNIE-NORTON PO BOX 888 Low/High rate: 4,500/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MENOMONEE FALLS WI 53052 Initial License: 01/01/2020 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 88 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MORGAN HOUSE (0015064) MCFI dba WHOLE HEALTH CLINICAL GROUP Type: CBRF HCBS COMPLIANT (414) 459-3014 Class: AA 3749 3751 S 80TH STREET EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53220 JORDAN FARNAND Gender - Capacity: F - 8 (414) 459-3014 JORDAN FARNAND 932 S 60TH STREET Low/High rate: 3,876/3,876 County: MILWAUKEE MILWAUKEE WI 53214 Initial License: 08/05/2014 NEW PERSPECTIVE FRANKLIN (0018068) FRANKLIN OPS LLC Type: CBRF HCBS COMPLIANT (952) 241-8211 Class: CNA 7220 SOUTH BALLPARK DRIVE ADVANCED AGED FRANKLIN WI 53132 PAM ENGLE Gender - Capacity: M/F - 60 (414) 263-9800 BRIAN JENNINGS 5900 CLEARWATER DRIVE STE 500 Low/High rate: 3,925/5,325 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MINNETONKA MN 55343 Initial License: 08/13/2020 PHYSICALLY DISABLED TERMINALLY ILL NEW PERSPECTIVE NORTH SHORE (0016219) BEAVER CREEK OPS LLC Type: CBRF HCBS COMPLIANT (952) 746-3630 Class: CNA 8875 N 60TH ST ADVANCED AGED BROWN DEER WI 53223 JENNA SPINELLI Gender - Capacity: M/F - 60 (414) 982-1551 ASHLEY ZIEGELBAUER 8875 N 60TH ST Low/High rate: 336/3,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE BROWN DEER WI 53223 Initial License: 07/19/2016 PHYSICALLY DISABLED TERMINALLY ILL NEXT STEP IN RESIDENTIAL SERVICES COVENTRY (0015 NEXT STEP IN RESIDENTIAL SERVICES LLC Type: CBRF HCBS COMPLIANT (262) 784-1840 Class: CNA 8028 W COVENTRY DR ADVANCED AGED FRANKLIN WI 53132 DOUG SVEDA Gender - Capacity: M/F - 5 DOUG SVEDA PO BOX 14185 Low/High rate: 5,747/5,747 DEVELOPMENTALLY DISABLED County: MILWAUKEE WEST ALLIS WI 53214 Initial License: 10/21/2014 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY NEXT STEP IN RESIDENTIAL SERVICES EDGERTON (0014 NEXT STEP IN RESIDENTIAL SERVICES, LLC Type: CBRF HCBS COMPLIANT (262) 784-1840 Class: CNA 5255 SOUTH 18TH STREET ADVANCED AGED MILWAUKEE WI 53221 DOUG SVEDA Gender - Capacity: M/F - 5 DOUG SVEDA PO BOX 14185 Low/High rate: 5,313/5,313 DEVELOPMENTALLY DISABLED County: MILWAUKEE WEST ALLIS WI 53214 Initial License: 06/18/2013 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY NEXT STEP IN RESIDENTIAL SERVICES RAMSEY (001660 NEXT STEP IN RESIDENTIAL SERVICES LLC Type: CBRF ADVANCED AGED (262) 784-1840 Class: CNA 2524 W RAMSEY AVE DEVELOPMENTALLY DISABLED MILWAUKEE WI 53221 DOUG SVEDA Gender - Capacity: M/F - 6 (414) 322-9939 DOUG SVEDA PO BOX 14185 Low/High rate: 3,968/4,492 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE WEST ALLIS WI 53214 Initial License: 05/09/2017 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY NEXT STEP IN RESIDENTIAL SERVICES WEST ALLIS (001 NEXT STEP IN RESIDENTIAL SERVICES LLC Type: CBRF ADVANCED AGED (262) 784-1840 Class: CNA 2577 S 118TH STREET DEVELOPMENTALLY DISABLED WEST ALLIS WI 53227 DOUG SVEDA Gender - Capacity: M/F - 6 (414) 541-4451 DOUG SVEDA PO BOX 14185 Low/High rate: 4,188/4,774 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE WEST ALLIS WI 53214 Initial License: 05/09/2017 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY NORTH 66TH ST (0010149) CREATIVE COMMUNITY LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: CNA 8484 N 66TH ST DEVELOPMENTALLY DISABLED BROWN DEER WI 53223 KATHRYN BERGEN Gender - Capacity: F - 6 (414) 371-1488 RICHARD CZERWAN 314 E MAIN ST Low/High rate: 3,411/6,493 PHYSICALLY DISABLED County: MILWAUKEE WATERTOWN WI 53094 Initial License: 12/01/2003 Association Approval: DSPN NORTH SHORE HOUSE (0012761) MILOUDI INC Type: CBRF HCBS COMPLIANT (262) 271-0993 Class: CS 6807 N SANTA MONICA BLVD ADVANCED AGED FOX POINT WI 53217 SAM HASSAN LAHRACHE Gender - Capacity: M/F - 8 (414) 351-9207 RAKESH PATEL W274 S4025 TIMBER TRAIL Low/High rate: 3,100/3,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53189 Initial License: 07/01/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 89 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

OAK CREEK PLACE (0014654) CREST AID OPCO LLC Type: CBRF ADVANCED AGED (415) 995-5135 Class: CNA 3829 S CHICAGO AVE IRREVERSIBLE DEMENTIA/ALZHEIM SOUTH MILWAUKEE WI 53172 Attn: POC/Legal Dept Gender - Capacity: M/F - 75 (414) 762-3838 MANDY GREASER 330 N. Wabash Ave., Ste. 3700 Low/High rate: 2,766/5,791 PHYSICALLY DISABLED County: MILWAUKEE Chicago IL 60611 Initial License: 07/11/2013 OAK CREST BLAKEWOOD HOME (0016631) VILLA OF GREENFIELD LLC Type: CBRF HCBS COMPLIANT (414) 427-0744 Class: CNA 3407 BLAKEWOOD AVE ADVANCED AGED SOUTH MILWAUKEE WI 53172 TIMOTHY GLOWINSKI Gender - Capacity: M/F - 8 (414) 427-0744 GIANNA GEORGE 8765 W FOREST HOME AVE Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE GREENFIELD WI 53228 Initial License: 05/02/2017 OAK CREST VILLA (0016630) VILLA OF GREENFIELD LLC Type: CBRF HCBS COMPLIANT (414) 427-0744 Class: CNA 8765 W FOREST HOME AVE ADVANCED AGED GREENFIELD WI 53228 TIMOTHY GLOWINSKI Gender - Capacity: M/F - 42 (414) 427-0744 GIANNA GEORGE 8765 W FOREST HOME AVE Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE GREENFIELD WI 53228 Initial License: 06/15/2017 Association Approval: WALA OAK PARK PLACE OF OAK CREEK (0017746) OAK PARK PLACE OF OAK CREEK LLC Type: CBRF ADVANCED AGED (608) 729-2910 Class: CNA 1980 WEST RAWSON AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM OAK CREEK WI 53154 HAYDEN FRANK Gender - Capacity: M/F - 90 (414) 216-3737 TIM BRABAND 719 JUPITER DRIVE Low/High rate: 2,100/4,300 County: MILWAUKEE MADISON WI 53718 Initial License: 12/12/2019 OAK PARK PLACE OF WAUWATOSA (0014395) OAK PARK PLACE OF WAUWATOSA LLC Type: CBRF HCBS COMPLIANT (608) 663-8728 Class: CNA 1621 RIVERS BEND ADVANCED AGED WAUWATOSA WI 53226 SCOTT FRANK Gender - Capacity: M/F - 75 (262) 902-8675 BRIANNA JOCHEM 719 JUPITER DR Low/High rate: 5,148/6,120 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MADISON WI 53718 Initial License: 11/26/2012 PHYSICALLY DISABLED PUBLIC FUNDING OAK RIDGE HOUSE (0012760) MILOUDI INC Type: CBRF HCBS COMPLIANT (262) 271-0993 Class: CS 2630 N 118TH ST ADVANCED AGED WAUWATOSA WI 53226 SAM HASSAN LAHRACHE Gender - Capacity: M/F - 8 (414) 258-6355 RAKESH PATEL W274 S4025 TIMBER TRAIL Low/High rate: 3,000/3,300 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53189 Initial License: 07/01/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM OHIO HOUSE (0015016) MCFI dba WHOLE HEALTH CLINICAL GROUP Type: CBRF HCBS COMPLIANT (414) 459-3014 Class: AA 3309 S 112TH STREET EMOTIONALLY DISTURBED/MENTAL WEST ALLIS WI 53227 JORDAN FARNAND Gender - Capacity: M - 8 (414) 459-3014 JORDAN FARNAND 932 S 60TH STREET Low/High rate: 5,460/5,460 County: MILWAUKEE MILWAUKEE WI 53214 Initial License: 07/28/2014 OKLAHOMA GROUP HOME (0012672) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: AA 3245 S 24TH ST EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53215 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 662-5777 JESSICA ZOCH 5555 N 51ST BLVD Low/High rate: 38,263/38,263 County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 05/01/2009 PALLADIUM ONE (0017860) PALLADIUM CARE LLC Type: CBRF ADVANCED AGED (414) 467-6326 Class: CNA 7911 N 47TH ST DEVELOPMENTALLY DISABLED BROWN DEER WI 53223 OLGA LISHANSKI Gender - Capacity: M/F - 8 (414) 354-4387 OLGA LISHANSKI 12525 N WOODLAND DR Low/High rate: 4,500/10,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MEQUON WI 53092 Initial License: 10/17/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY PALLADIUM TWO (0017861) PALLADIUM CARE LLC Type: CBRF ADVANCED AGED (414) 467-6326 Class: CNA 7909 N 47TH ST DEVELOPMENTALLY DISABLED BROWN DEER WI 53223 OLGA LISHANSKI Gender - Capacity: M/F - 8 (414) 354-4386 OLGA LISHANSKI 12525 N WOODLAND DR Low/High rate: 4,500/10,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MEQUON WI 53092 Initial License: 10/17/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 90 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PARK HILLS WEST (0017154) GOLDEN MILLENNIUM ENTERPRISES LLC Type: CBRF ADVANCED AGED (414) 803-3497 Class: CNA 5910 S 118TH ST DEVELOPMENTALLY DISABLED HALES CORNERS WI 53130 VITALIY GORELIK Gender - Capacity: M/F - 20 (414) 803-3497 VITALIY GORELIK 3701 W SHERBROOKE DR Low/High rate: 3,446/6,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MEQUON WI 53092 Initial License: 07/13/2018 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY PARKWAY HOUSE (0012752) MILOUDI INC Type: CBRF HCBS COMPLIANT (262) 271-0993 Class: AS 2780 N MENOMONEE RIVER PKWY ADVANCED AGED MILWAUKEE WI 53222 SAM HASSAN LAHRACHE Gender - Capacity: M/F - 8 (414) 771-7326 RAKESH PATEL W274 S4025 TIMBER TRAIL Low/High rate: 3,180/3,450 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53189 Initial License: 07/01/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING PARKWOOD ASSISTED LIVING GREEN HOUSE (0015217) PARKWOOD ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (630) 202-2539 Class: CNA 6370 N GREEN BAY AVE ADVANCED AGED GLENDALE WI 53209 TONY LAHRACHE Gender - Capacity: M/F - 12 (414) 797-2603 TONY LAHRACHE 1617 DOVER DRIVE UNIT 14 Low/High rate: 3,200/3,900 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53186 Initial License: 07/01/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING PARKWOOD ASSISTED LIVING MILL HOUSE (0015216) PARKWOOD ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (414) 774-1740 Class: CNA 6378 N GREEN BAY AVE ADVANCED AGED GLENDALE WI 53209 TONY LAHRACHE Gender - Capacity: M/F - 15 (414) 228-8996 PENNY DUFF 1617 DOVER DRIVE UNIT 14 Low/High rate: 3,200/4,100 DEVELOPMENTALLY DISABLED County: MILWAUKEE WAUKESHA WI 53186 Initial License: 07/01/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING PARSONS HOUSE (310022) WISCONSIN COMMUNITY SERVICES INC Type: CBRF CORRECTIONAL CLIENTS 2930 N 25TH ST (414) 290-0400 Class: AA MILWAUKEE WI 53206 ARTIS LANDON Gender - Capacity: M/F - 40 (414) 445-3301 ARTIS LANDON 3732 W WISCONSIN AVE SUITE 320 Low/High rate: 0/2,708 County: MILWAUKEE MILWAUKEE WI 53208 Initial License: 05/24/1983 PEACE RESIDENTIAL HOME (310223) PEACE RESIDENTIAL HOME INC Type: CBRF HCBS COMPLIANT (414) 353-4441 Class: CNA 6477 N 91ST ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53224 DONNA VORPAGEL Gender - Capacity: M/F - 8 (414) 353-4441 DONNA VORPAGEL 6477 N 91ST ST Low/High rate: 2,184/2,586 County: MILWAUKEE MILWAUKEE WI 53224 Initial License: 01/10/1995 PEACEFUL BLESSED HOME (0015456) PEACEFUL BLESSED HOME Type: CBRF HCBS COMPLIANT (414) 625-0500 Class: CNA 2324 W WHITAKER AVE ADVANCED AGED MILWAUKEE WI 53221 MAHMOUD RAYYAN Gender - Capacity: M/F - 8 (414) 625-0500 SAMRA YAN 2324 W WHITAKER AVE Low/High rate: 2,900/3,300 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53221 Initial License: 01/15/2016 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY PINE HAVEN (0011114) INDEPENDENT LIFESTYLES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CNA 6795 S 51ST ST ADVANCED AGED FRANKLIN WI 53132 DAN HOECHERL Gender - Capacity: M/F - 12 (414) 421-8010 DAN HOECHERL 4405 S DEERWOOD DR Low/High rate: 3,390/3,456 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151-9240 Initial License: 02/01/2006 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 91 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PRESTIGIOUS ACADEMY INC (0010546) PRESTIGIOUS ACADEMY INC Type: CBRF HCBS COMPLIANT (414) 265-8181 Class: AA 2624 N 16TH ST ADVANCED AGED MILWAUKEE WI 53206 VERDELLA HARVEY Gender - Capacity: M/F - 8 (414) 265-8181 VERDELLA HARVEY PO BOX 6468 Low/High rate: 3,600/4,200 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53206 Initial License: 01/05/2005 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING PRESTIGIOUS ACADEMY INC II (0011926) PRESTIGIOUS ACADEMY INC Type: CBRF HCBS COMPLIANT (414) 247-9444 Class: AA 2628 N 16TH ST ADVANCED AGED MILWAUKEE WI 53206 VERDELLA HARVEY Gender - Capacity: M/F - 8 (414) 265-8181 VERDELLA HARVEY PO BOX 6468 Low/High rate: 2,750/3,750 ALCOHOL/DRUG DEPENDENT County: MILWAUKEE MILWAUKEE WI 53206 Initial License: 08/04/2008 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PRIMROSE RESIDENTIAL FACILITY (0009366) SHIRLEY GLADNEY Type: CBRF HCBS COMPLIANT (414) 462-0802 Class: AA 3910 3910A W BURLEIGH ST ADVANCED AGED MILWAUKEE WI 53210 SHIRLEY GLADNEY Gender - Capacity: M/F - 7 (414) 445-3607 SHIRLEY GLADNEY 3910 W BURLEIGH ST Low/High rate: 3,500/4,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53210 Initial License: 04/05/2002 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING RAINBOW PARK HOUSE (0017600) RAINBOW PARK HOUSE LLC Type: CBRF HCBS COMPLIANT (262) 271-6512 Class: CNA 1217 S 118TH ST ADVANCED AGED WEST ALLIS WI 53214 SAM LAHRACHE Gender - Capacity: M/F - 8 (262) 271-6512 Sam Lahrache 1217 S 118TH ST Low/High rate: 3,200/3,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE WEST ALLIS WI 53214 Initial License: 06/18/2019 EMOTIONALLY DISTURBED/MENTAL RAMSEY WOODS RESIDENCE (0017132) ARHC RWCUDWI01 TRS LLC C/O HEALTHCARE T Type: CBRF ADVANCED AGED (212) 415-6500 Class: CNA 3210 E RAMSEY AVE IRREVERSIBLE DEMENTIA/ALZHEIM CUDAHY WI 53110 Monique Gazdik Gender - Capacity: M/F - 33 (414) 744-4663 Monique Gazdik 3210 E RAMSEY AVE Low/High rate: 5,200/7,200 PHYSICALLY DISABLED County: MILWAUKEE CUDAHY WI 53110 Initial License: 02/28/2019 PUBLIC FUNDING TERMINALLY ILL RAVENSWOOD MANOR (310622) INDEPENDENT LIFESTYLES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CS 8454 RAVENSWOOD CIRCLE ADVANCED AGED WAUWATOSA WI 53226 DAN HOECHERL Gender - Capacity: M/F - 8 (414) 443-0646 DAN HOECHERL 4405 S DEERWOOD DR Low/High rate: 3,033/3,148 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151 Initial License: 11/18/1996 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM REM WISCONSIN II INC COLLEGE AVE (0010402) REM WISCONSIN II INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA 3177 W COLLEGE AVE ADVANCED AGED FRANKLIN WI 53132 LORI WRIGHT Gender - Capacity: M/F - 6 (414) 761-1943 DEBBIE GEER 4033 123rd ST,STE A Low/High rate: 7,082/7,895 DEVELOPMENTALLY DISABLED County: MILWAUKEE CHIPPEWA FALLS WI 54729 Initial License: 09/13/2004 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY REM WISCONSIN II INC NICHOLSON (0010403) REM WISCONSIN II INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA 1009 NICHOLSON AVE DEVELOPMENTALLY DISABLED SOUTH MILWAUKEE WI 53172 LORI WRIGHT Gender - Capacity: M/F - 6 (414) 768-5554 DEBBIE GEER 4033 123rd ST, STE A Low/High rate: 6,083/7,908 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE CHIPPEWA FALLS WI 54729 Initial License: 12/26/2003 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY RESIDENTIAL LIVING SERVICES (310204) RESIDENTIAL LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (414) 345-8243 Class: CA 1628 N 19TH ST ADVANCED AGED MILWAUKEE WI 53205 JOANN HARRIS Gender - Capacity: M/F - 7 (414) 342-9324 JOANN HARRIS PO BOX 05613 Low/High rate: 3,300/3,300 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53205 Initial License: 09/15/1994 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 92 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

RESIDENTIAL LIVING SERVICES II (310271) RESIDENTIAL LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (414) 933-3929 Class: CNA 1624 N 19TH ST ADVANCED AGED MILWAUKEE WI 53205 JOANN HARRIS Gender - Capacity: M/F - 7 (414) 345-8243 JOANN HARRIS PO BOX 05613 Low/High rate: 3,300/3,300 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53205 Initial License: 03/03/1998 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED RIVERSIDE TERRACE (0008995) LIFECARE HOMES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CS 5883 W RIVERSIDE DR ADVANCED AGED GREENDALE WI 53129 DAN HOECHERL Gender - Capacity: M/F - 8 (414) 423-4289 DAN HOECHERL 4405 S DEERWOOD DR Low/High rate: 3,741/3,741 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151 Initial License: 05/12/2000 EMOTIONALLY DISTURBED/MENTAL ROBINWOOD MANOR (310234) LIFECARE HOMES INC Type: CBRF HCBS COMPLIANT (262) 782-6068 Class: CS 10520 W ROBINWOOD LN ADVANCED AGED FRANKLIN WI 53132 DAN HOECHERL Gender - Capacity: M/F - 8 (414) 427-9959 DAN HOECHERL 4405 S DEERWOOD DR Low/High rate: 3,222/3,222 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53151 Initial License: 12/02/1994 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED ROGERS MEMORIAL HOSPITAL WEST ALLIS RECOVERY ROGERS MEMORIAL HOSPITAL INC Type: CBRF ALCOHOL/DRUG DEPENDENT (262) 646-4411 Class: AA 11101 W LINCOLN AVE EMOTIONALLY DISTURBED/MENTAL WEST ALLIS WI 53227 TERESA SCHULTZ Gender - Capacity: M/F - 28 (262) 646-1123 KIMBERLY EFFERTZ 34700 VALLEY RD Low/High rate: 28,560/28,560 County: MILWAUKEE OCONOMOWOC WI 53066 Initial License: 07/10/2019 ROOT RIVER HAVEN (0014968) BRYANT HOMES LLC Type: CBRF HCBS COMPLIANT (414) 241-7067 Class: AA 3161 S 112TH ST DEVELOPMENTALLY DISABLED WEST ALLIS WI 53227 CANDACE DAHLKE Gender - Capacity: M/F - 8 (414) 321-5960 CANDACE DAHLKE 12501 W NEEDHAM DRIVE Low/High rate: 3,700/3,752 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE NEW BERLIN WI 53132 Initial License: 03/11/2014 IRREVERSIBLE DEMENTIA/ALZHEIM TRAUMATIC BRAIN INJURY RUBY CASTLE (0015522) Castle Senior Living Inc Type: CBRF HCBS COMPLIANT (414) 607-3776 Class: CNA 1234 S 112 Street ADVANCED AGED West Allis WI 53214 Kristopher Kiefer Gender - Capacity: M/F - 8 (414) 607-3776 MICHELLE GREEN 1234 S 112 Street Low/High rate: 3,800/5,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE West Allis WI 53214 Initial License: 02/19/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA SAINT JOHNS ON THE LAKE (0017822) SAINT JOHNS COMMUNITIES INC Type: CBRF ADVANCED AGED (414) 831-6880 Class: CNA 1858 N PROSPECT AVE IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53202 JOHN GEORGE Gender - Capacity: M/F - 60 (414) 272-2022 JOHN GEORGE 1840 N PROSPECT AVE Low/High rate: 6,560/8,110 PHYSICALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53202 Initial License: 01/08/2020 Association Approval: LeadingAge Wisconsin SERENITY BLESSED HOME (0017413) SERENITY BLESSED HOME LLC Type: CBRF HCBS COMPLIANT (414) 308-0807 Class: CNA 7937 W HOLMES AVE ADVANCED AGED MILWAUKEE WI 53220 MAHMOUD RAYYAN Gender - Capacity: M/F - 8 (414) 308-0807 ESLAM RAYYAN 7937 W HOLMES AVE Low/High rate: 5,500/7,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE GREENDALE WI 53220 Initial License: 01/21/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 93 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SIENNA CASTLE (0015519) Castle Senior Living Inc Type: CBRF HCBS COMPLIANT (414) 427-1655 Class: CNA 9640 W. Layton Avenue ADVANCED AGED Greenfield WI 53228 MICHELLE GREEN Gender - Capacity: M/F - 8 (414) 529-9910 MICHELLE GREEN 13050 W CLEVELAND AVE Low/High rate: 4,200/5,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE NEW BERLIN WI 53131 Initial License: 02/19/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA SILVER VIEW LLC (0012742) SILVER VIEW LLC Type: CBRF HCBS COMPLIANT (262) 989-5382 Class: CNA 9215 W SILVER SPRING DR ADVANCED AGED MILWAUKEE WI 53225 MARY FILLER Gender - Capacity: M/F - 23 (414) 464-0557 DESNY ESTES 19913 SPRING ST Low/High rate: 2,800/3,700 DEVELOPMENTALLY DISABLED County: MILWAUKEE UNION GROVE WI 53182 Initial License: 04/08/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING SILVERADO NORTH SHORE (0017408) SILVERADO NORTH SHORE LLC Type: CBRF ADVANCED AGED 7800 N GREEN BAY RD (949) 240-7200 Class: CNA GLENDALE WI 53217 ERIN GUTSMIEDL Gender - Capacity: M/F - 85 (412) 269-6598 ERIN GUTSMIEDL 6400 OAK CANYON STE 200 Low/High rate: 7,500/11,100 County: MILWAUKEE IRVINE CA 92618 Initial License: 08/16/2018 SKY RESIDENTIAL FRANKLIN (0012151) SKY RESIDENTIAL SERVICES INC Type: CBRF HCBS COMPLIANT (414) 534-2979 Class: CNA 8104 S 35TH ST ADVANCED AGED FRANKLIN WI 53132 KIM NGUYEN Gender - Capacity: M/F - 6 (414) 421-1886 KIM NGUYEN N94 W20846 SCHLEI RD Low/High rate: 5,740/7,750 DEVELOPMENTALLY DISABLED County: MILWAUKEE MENOMONEE FALLS WI 53051 Initial License: 11/01/2007 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY SOUTH SHORE HOUSE (0016639) SS L2S OPERATIONS LLC Type: CBRF ADVANCED AGED (309) 368-1825 Class: AS 6168 S SWIFT AVE DEVELOPMENTALLY DISABLED CUDAHY WI 53110 DANIELLE MOREY Gender - Capacity: M/F - 8 (414) 762-6005 DANIELLE MOREY 8141 FOLEY ROAD Low/High rate: 3,400/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE RACINE WI 53402 Initial License: 06/20/2017 ST ANNES HOME FOR THE ELDERLY CBRF (0012345) ST ANNES HOME FOR THE ELDERLY MILWAUKE Type: CBRF ADVANCED AGED (414) 463-7570 Class: CNA 3800 N 92ND ST IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53222 JANET KRAHN Gender - Capacity: M/F - 55 (414) 463-7570 JANET KRAHN 3800 N 92ND ST Low/High rate: 5,100/6,400 County: MILWAUKEE MILWAUKEE WI 53222 Initial License: 03/31/2009 ST ANNES MISSION COURT CBRF (0015711) ST ANNES HOME FOR THE ELDERLY MILW INC Type: CBRF ADVANCED AGED (414) 463-7570 Class: CNA 3800 N 92ND STREET IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53222 JANET KRAHN Gender - Capacity: M/F - 28 (414) 463-7570 JANET KRAHN 3800 N 92ND STREET Low/High rate: 5,100/5,700 PHYSICALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53222 Initial License: 09/28/2015 PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin ST CAMILLUS (0011293) SAN CAMILLO INC Type: CBRF HCBS COMPLIANT (414) 258-1814 Class: CNA 10101 W WISCONSIN AVE ADVANCED AGED WAUWATOSA WI 53226 BRANDON LUKE Gender - Capacity: M/F - 86 (414) 258-1814 SHANNON ANGELL 10101 W WISCONSIN AVE Low/High rate: 5,235/7,180 PUBLIC FUNDING County: MILWAUKEE WAUWATOSA WI 53226 Initial License: 01/12/2006 Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 94 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ST CAMILLUS MEMORY CARE NORTH RESIDENCE (00168 ST CAMILLUS HEALTH CENTER INC Type: CBRF ADVANCED AGED (414) 258-1814 Class: CNA 10201 W WISCONSIN AVE IRREVERSIBLE DEMENTIA/ALZHEIM WAUWATOSA WI 53226 COURTNEY WILSON Gender - Capacity: M/F - 65 (414) 258-1814 COURTNEY WILSON 10201 W WISCONSIN AVE Low/High rate: 7,115/9,675 County: MILWAUKEE WAUWATOSA WI 53226 Initial License: 02/16/2018 ST JOHNS MANOR (0017906) BUZARG LLC Type: CBRF HCBS COMPLIANT (608) 239-4984 Class: CS 812 MARQUETTE AVENUE ADVANCED AGED SOUTH MILWAUKEE WI 53172 MOHAMMED HASHIM-WARIS Gender - Capacity: M/F - 27 (414) 762-2511 MOHAMMED HASHIM-WARIS 21 PRAIRIE HILL COURT Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MADISON WI 53719 Initial License: 01/24/2020 PHYSICALLY DISABLED ST MARYS MANOR (0015178) SOUTH MILWAUKEE COMMUNITY LIVING CENTE Type: CBRF HCBS COMPLIANT (414) 208-6678 Class: CNA 1313 MISSOURI AVENUE ADVANCED AGED SOUTH MILWAUKEE WI 53172 KRISTIN BUCEK Gender - Capacity: M/F - 17 (414) 762-8026 KRISTIN BUCEK 22218 W 7 MILE ROAD Low/High rate: 3,500/3,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE FRANKSVILLE WI 53126 Initial License: 10/01/2014 PUBLIC FUNDING ST RITA SQUARE I (0018202) CAPRI COMMUNITIES LLC Type: CBRF ADVANCED AGED (262) 798-1224 Class: CNA 728 EAST PLEASANT STREET IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53202 GLEN CHOBAN Gender - Capacity: M/F - 22 (414) 485-6600 TYLER PALZKILL 20875 CROSSROADS CIRCLE Low/High rate: 3,575/9,475 PHYSICALLY DISABLED County: MILWAUKEE WAUKESHA WI 53186 Initial License: 08/20/2020 TERMINALLY ILL ST RITA SQUARE II (0018203) CAPRI COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (262) 798-1224 Class: CNA 728 EAST PLEASANT STREET ADVANCED AGED MILWAUKEE WI 53202 GLEN CHOBAN Gender - Capacity: M/F - 28 (414) 485-6600 TYLER PALZKILL 20875 CROSSROADS CIRCLE Low/High rate: 6,385/9,125 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE WAUKESHA WI 53186 Initial License: 08/20/2020 PHYSICALLY DISABLED TERMINALLY ILL SUITES AT GREENFIELD (THE) (0016898) THE SUITES AT GREENFIELD Type: CBRF ADVANCED AGED (414) 282-1300 Class: CNA 5790 S 27TH ST EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53221 ANNETTE BOHMAN Gender - Capacity: M/F - 49 (414) 282-1300 ANNETTE BOHMAN 5790 S 27TH ST Low/High rate: 4,000/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MILWAUKEE WI 53221 Initial License: 02/22/2018 PHYSICALLY DISABLED TERMINALLY ILL SYLVAN CROSSINGS AT CREEKSIDE ESTATES (0009038) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 6180 S CREEKSIDE DR ADVANCED AGED CUDAHY WI 53110 DANIEL FLEMING Gender - Capacity: M/F - 20 (414) 762-7408 SHELLEY BECKETT 2960 TRIVERTON PIKE Low/High rate: 3,950/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MADISON WI 53711 Initial License: 09/30/2000 PUBLIC FUNDING TERMINALLY ILL SYLVAN CROSSINGS AT CREEKSIDE ESTATES (0009038) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 6180 S CREEKSIDE DR ADVANCED AGED CUDAHY WI 53110 DANIEL FLEMING Gender - Capacity: M/F - 20 (414) 762-7408 SHELLEY BECKETT 2960 TRIVERTON PIKE Low/High rate: 3,950/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE MADISON WI 53711 Initial License: 09/30/2000 PUBLIC FUNDING TERMINALLY ILL TALL OAKS OF WEST ALLIS (0018221) LEUROCK HOLDINGS LLC Type: CBRF HCBS COMPLIANT (414) 628-9030 Class: CS 2825 SOUTH WAUKESHA ROAD ADVANCED AGED WEST ALLIS WI 53227 CHRIS OCHI Gender - Capacity: M/F - 20 (414) 321-7101 CHRIS OCHI 9600 WEST BARNARD AVENUE Low/High rate: 5,000/12,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE GREENFIELD WI 53228 Initial License: 09/15/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM THIS HOUSE IS A HOME CBRF (0017247) THIS HOUSE IS A HOME CBRF LLC Type: CBRF DEVELOPMENTALLY DISABLED (414) 745-4392 Class: CNA 10135 W HAMPTON AVE STE 1 EMOTIONALLY DISTURBED/MENTAL MILWAUKEE WI 53225 KAI TRIMBLE Gender - Capacity: M/F - 8 (414) 975-2658 KAI TRIMBLE 10135 W Hampton Ave STE 1 Low/High rate: 3,000/15,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE Milwaukee WI 53225 Initial License: 12/01/2019 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY TREE OF LIFE GREENFIELD (0016957) TREE OF LIFE ASSISTED LIVING GREENFIELD L Type: CBRF HCBS COMPLIANT (414) 213-2066 Class: CNA 3171 S 100TH ST ADVANCED AGED GREENFIELD WI 53227 ANA ROJAS Gender - Capacity: M/F - 8 (262) 886-2007 LUCERO AYALA 6507 OPEN MEADOW RD Low/High rate: 4,212/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE CALEDONIA WI 53402 Initial License: 08/10/2018 PHYSICALLY DISABLED

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 95 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

TRINITY HEALTH CARE INC (0009472) TRINITY HEALTH CARE INC Type: CBRF HCBS COMPLIANT (414) 466-6664 Class: CNA 5605 W CUSTER AVE ADVANCED AGED MILWAUKEE WI 53218 FOLAKE ROSE ADENIYI Gender - Capacity: F - 6 (414) 466-6664 FOLAKE ROSE ADENIYI 5605 W CUSTER AVE Low/High rate: 3,151/3,900 DEVELOPMENTALLY DISABLED County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 01/23/2002 PHYSICALLY DISABLED UNCAS HOUSE (0015900) MATT TALBOT RECOVERY SERVICES INC Type: CBRF EMOTIONALLY DISTURBED/MENTAL (414) 342-5474 Class: CNA 429 WEST UNCAS AVENUE PUBLIC FUNDING MILWAUKEE WI 53207 KARL RAJANI Gender - Capacity: M - 8 (414) 510-7668 ANTONEO DESHAZOR PO BOX 20007 Low/High rate: 600/18,000 County: MILWAUKEE GREENFIELD WI 53220-0007 Initial License: 12/28/2015 UNITED COMMUNITY CENTER ART 1 (0012894) UNITED COMMUNITY CENTER INC Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 384-3100 Class: AA 604 W SCOTT ST PUBLIC FUNDING MILWAUKEE WI 53204 JUAN A. RUIZ Gender - Capacity: M - 15 (414) 643-8530 JUAN RUIZ 1028 S 9TH ST Low/High rate: 4,440/4,440 County: MILWAUKEE MILWAUKEE WI 53204 Initial License: 08/13/2009 UNITED COMMUNITY CENTER LATINAS UNIDAS 2 (00165 UNITED COMMUNITY CENTER Type: CBRF ALCOHOL/DRUG DEPENDENT 614 W SCOTT ST (414) 384-3100 Class: AA MILWAUKEE WI 53204 JUAN RUIZ Gender - Capacity: F - 16 (414) 643-8530 JUAN RUIZ 1028 S 9TH ST Low/High rate: 146/250 County: MILWAUKEE MILWAUKEE WI 53204 Initial License: 04/27/2017 VILLA ST FRANCIS (310120) VILLA ST FRANCIS INC Type: CBRF ADVANCED AGED (414) 649-2888 Class: CNA 1910 W OHIO AVE IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53215 SUSAN SEEGERT Gender - Capacity: M/F - 134 (414) 649-2888 SUSAN SEEGERT 1910 W OHIO AVE Low/High rate: 3,300/8,644 PUBLIC FUNDING County: MILWAUKEE MILWAUKEE WI 53215 Initial License: 10/18/1990 TRAUMATIC BRAIN INJURY VILLA ST FRANCIS (310120) VILLA ST FRANCIS INC Type: CBRF ADVANCED AGED (414) 649-2888 Class: CNA 1910 W OHIO AVE IRREVERSIBLE DEMENTIA/ALZHEIM MILWAUKEE WI 53215 SUSAN SEEGERT Gender - Capacity: M/F - 134 (414) 649-2888 SUSAN SEEGERT 1910 W OHIO AVE Low/High rate: 3,300/8,644 PUBLIC FUNDING County: MILWAUKEE MILWAUKEE WI 53215 Initial License: 10/18/1990 TRAUMATIC BRAIN INJURY Association Approval: LeadingAge Wisconsin VILLAGE AT MANOR PARK PALMER HOUSE (310053) METHODIST MANOR INC Type: CBRF HCBS COMPLIANT (414) 607-4100 Class: CNA 3023 S 84TH ST ADVANCED AGED WEST ALLIS WI 53227 SUSAN BORKOWSKI Gender - Capacity: M/F - 130 (414) 607-4100 Briana Weyker 3023 S 84TH ST Low/High rate: 3,750/4,425 IRREVERSIBLE DEMENTIA/ALZHEIM County: MILWAUKEE WEST ALLIS WI 53227 Initial License: 04/01/1980 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin VILLARD CRC (0015017) MCFI dba WHOLE HEALTH CLINICAL GROUP Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 459-3014 Class: AA 5409 VILLARD AVENUE DEVELOPMENTALLY DISABLED MILWAUKEE WI 53225 JOHN CHIANELLI Gender - Capacity: M/F - 12 (414) 476-9675 JOHN CHIANELLI 932 S 60TH STREET Low/High rate: 13,500/13,500 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53214 Initial License: 08/11/2014 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY WABASH HOME (0017608) WILLOWBROOK SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (217) 553-3065 Class: AS 7716 W WABASH CT ADVANCED AGED MILWAUKEE WI 53223 KUROSH DEJGOSHA Gender - Capacity: M/F - 20 (414) 797-2343 Kurosh Dejosha 1345 N JEFFERSON ST STE 328 Low/High rate: 3,000/6,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53202 Initial License: 05/01/2019 PUBLIC FUNDING Association Approval: WALA WAHNER HOUSE (310648) MT CASTLE CORPORATION Type: CBRF HCBS COMPLIANT (414) 540-6479 Class: CNA 5765 W WAHNER DR DEVELOPMENTALLY DISABLED BROWN DEER WI 53223 SCOTT WILDER Gender - Capacity: M/F - 5 (414) 355-3364 SCOTT WILDER 3808 W ELM ST Low/High rate: 3,000/3,700 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53209 Initial License: 10/02/1997 WASHINGTON HEIGHTS MANOR (0012706) WORLDWIDE ESTATE INC Type: CBRF HCBS COMPLIANT (262) 389-1461 Class: AA 1506 1510 N 48TH ST ADVANCED AGED MILWAUKEE WI 53208 RAKESH PATEL Gender - Capacity: M/F - 8 (262) 389-1461 RAKESH/SHANNON PATEL PO BOX 601 Low/High rate: 3,200/7,500 DEVELOPMENTALLY DISABLED County: MILWAUKEE BUTLER WI 53007 Initial License: 03/30/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 96 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

WASHINGTON HEIGHTS MANOR II (0016797) WORLDWIDE ESTATE INC Type: CBRF ADVANCED AGED (262) 389-1461 Class: AA 10620 W GREENWOOD TERRACE DEVELOPMENTALLY DISABLED MILWAUKEE WI 53224 RAKESH PATEL Gender - Capacity: M/F - 8 (262) 389-1461 RAKESH PATEL 12420 HAMPTON AVE PO BOX 601 Low/High rate: 3,000/8,000 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE BUTLER WI 53007 Initial License: 08/15/2017 IRREVERSIBLE DEMENTIA/ALZHEIM TRAUMATIC BRAIN INJURY WATERS OF OAK CREEK (THE) (0017496) THE WATERS OF OAK CREEK LLC Type: CBRF ADVANCED AGED (952) 358-5100 Class: CNA 8000 S MARKET ST IRREVERSIBLE DEMENTIA/ALZHEIM OAK CREEK WI 53154 LORI STROMMEN Gender - Capacity: M/F - 16 (414) 574-0900 DANIEL BUDRECK 1600 HOPKINS CROSSROADS Low/High rate: 3,500/9,500 County: MILWAUKEE MINNETONKA MN 55305 Initial License: 03/29/2019 WHITE BIRCH TERRACE (310653) ATHENA SPS LLC WHITE BIRCH TERRACE Type: CBRF HCBS COMPLIANT (414) 247-1771 Class: ANA 8500 N GREENVALE RD ADVANCED AGED BAYSIDE WI 53217 PATRICIA WESTPHAL Gender - Capacity: M/F - 8 (414) 247-1771 PATRICIA WESTPHAL 8500 N GREENVALE RD Low/High rate: 3,789/5,000 DEVELOPMENTALLY DISABLED County: MILWAUKEE BAYSIDE WI 53217 Initial License: 01/14/1998 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING WHOLE HEALTH CLINICAL GROUP (0018128) MCFI dba WHOLE HEALTH CLINICAL GROUP Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 476-9675 Class: AA 5566 NORTH 69TH STREET DEVELOPMENTALLY DISABLED MILWAUKEE WI 53203 JOHN CHIANELLI Gender - Capacity: M/F - 12 (414) 476-9631 JOHN CHIANELLI 932 SOUTH 60TH STREET Low/High rate: 0/0 EMOTIONALLY DISTURBED/MENTAL County: MILWAUKEE MILWAUKEE WI 53214 Initial License: 02/25/2021 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY WILLOWGLEN ACADEMY HOWARD HOUSE (310672) PHOENIX CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (414) 527-6970 Class: CA 3959 3961 S 51ST ST DEVELOPMENTALLY DISABLED MILWAUKEE WI 53220 JESSICA ZOCH Gender - Capacity: M/F - 8 (414) 527-6970 JESSICA ZOCH 5555 N 51 ST BLVD Low/High rate: 4,224/8,332 County: MILWAUKEE MILWAUKEE WI 53218 Initial License: 05/01/1992 AGAPE ACRES LLC (0011150) TAMMY M EWERT Type: CBRF HCBS COMPLIANT (608) 378-5054 Class: CNA 3737 BLUEBERRY RD ADVANCED AGED WARRENS WI 54666 TAMMY EWERT Gender - Capacity: M/F - 15 (608) 378-4054 TAMMY EWERT 3737 BLUEBERRY RD Low/High rate: 2,600/3,600 DEVELOPMENTALLY DISABLED County: MONROE WARRENS WI 54666 Initial License: 12/21/2005 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ANN ST HOUSE (0017991) WINDY RIDGE CARE INC Type: CBRF HCBS COMPLIANT (608) 343-1177 Class: CS 321 ANN STREET ALCOHOL/DRUG DEPENDENT TOMAH WI 54660 GLORIA DIPPEN Gender - Capacity: M/F - 8 (608) 343-1177 GLORIA DIPPEN PO BOX 126 Low/High rate: 3,000/10,000 DEVELOPMENTALLY DISABLED County: MONROE WILTON WI 54670 Initial License: 03/25/2020 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BRIDGE PATH (0013540) MORROW MEMORIAL HOME FOR THE AGED INC Type: CBRF ADVANCED AGED (608) 269-3168 Class: CNA 503 S WATER STREET IRREVERSIBLE DEMENTIA/ALZHEIM SPARTA WI 54656 DANIEL MEYER Gender - Capacity: M/F - 28 (608) 269-3168 LAWRENCE SCHMITZ 331 S WATER ST Low/High rate: 4,675/4,845 PUBLIC FUNDING County: MONROE SPARTA WI 54656 Initial License: 01/25/2011 BRIDGE PATH (0013540) MORROW MEMORIAL HOME FOR THE AGED INC Type: CBRF ADVANCED AGED (608) 269-3168 Class: CNA 503 S WATER STREET IRREVERSIBLE DEMENTIA/ALZHEIM SPARTA WI 54656 DANIEL MEYER Gender - Capacity: M/F - 28 (608) 269-3168 LAWRENCE SCHMITZ 331 S WATER ST Low/High rate: 4,675/4,845 PUBLIC FUNDING County: MONROE SPARTA WI 54656 Initial License: 01/25/2011 Association Approval: LeadingAge Wisconsin CLOSE TO HOME INC (510383) CLOSE TO HOME INC Type: CBRF ADVANCED AGED (608) 372-2696 Class: CNA 1206 MARK AVE IRREVERSIBLE DEMENTIA/ALZHEIM TOMAH WI 54660 ROBERTA DIETZMAN Gender - Capacity: M/F - 16 (608) 374-5300 ROBERTA DIETZMAN 1211 MARK AVENUE Low/High rate: 2,542/3,400 County: MONROE TOMAH WI 54660 Initial License: 02/23/1998

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 97 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CRANBERRY COURT I LLC (0010457) CRANBERRY COURT LLC Type: CBRF HCBS COMPLIANT (608) 372-5070 Class: CNA 1031 HEELER AVE ADVANCED AGED TOMAH WI 54660 KRISTA WITT Gender - Capacity: M/F - 14 (608) 372-5070 KRISTA WITT 1031 HEELER AVE Low/High rate: 2,800/3,800 DEVELOPMENTALLY DISABLED County: MONROE TOMAH WI 54660 Initial License: 01/01/2004 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY CRANBERRY COURT LLC BLDG 2 (0010577) CRANBERRY COURT LLC Type: CBRF HCBS COMPLIANT (608) 372-5070 Class: CNA 1025 HEELER AVE ADVANCED AGED TOMAH WI 54660 KRISTA WITT Gender - Capacity: M/F - 14 (608) 372-5070 KRISTA WITT 1031 HEELER AVE Low/High rate: 2,000/3,450 DEVELOPMENTALLY DISABLED County: MONROE TOMAH WI 54660 Initial License: 04/16/2004 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY DEER VALLEY CARES LLC (0018340) DEER VALLEY CARES LLC Type: CBRF HCBS COMPLIANT (608) 604-6587 Class: CS 18067 COUNTY HIGHWAY F ADVANCED AGED NORWALK WI 54648 SARAH PEAT Gender - Capacity: M/F - 6 (608) 823-7278 SARAH PEAT 31280 FRESNO AVENUE Low/High rate: 3,000/10,000 ALCOHOL/DRUG DEPENDENT County: MONROE TOMAH WI 54660 Initial License: 01/25/2021 CORRECTIONAL CLIENTS DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY GREENFIELD HOUSE (THE) (0009602) GREENFIELD HOUSE INC (THE) Type: CBRF HCBS COMPLIANT (608) 372-7331 Class: CNA 21444 FLATIRON AVENUE ADVANCED AGED TOMAH WI 54660 MELISSA SHARP Gender - Capacity: M/F - 14 (608) 372-7335 MELISSA SHARP 21444 FLATIRON AVENUE Low/High rate: 2,700/3,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: MONROE TOMAH WI 54660 Initial License: 03/30/2002 PUBLIC FUNDING TERMINALLY ILL HOLTON HOUSE (0016508) WINDY RIDGE CARE INC Type: CBRF HCBS COMPLIANT (608) 343-1177 Class: AA 315 E HOLTON DEVELOPMENTALLY DISABLED TOMAH WI 54660 GLORIA DIPPEN Gender - Capacity: F - 6 (608) 567-0183 GLORIA DIPPEN PO BOX 126 Low/High rate: 3,000/8,000 EMOTIONALLY DISTURBED/MENTAL County: MONROE WILTON WI 54670 Initial License: 05/02/2017 PHYSICALLY DISABLED JACKSON ST HOUSE (0017999) WINDY RIDGE CARE INC Type: CBRF HCBS COMPLIANT (608) 343-1177 Class: CNA 300 BUTTS AVENUE ALCOHOL/DRUG DEPENDENT TOMAH WI 54660 GLORIA DIPPEN Gender - Capacity: M/F - 8 (608) 343-1177 GLORIA DIPPEN PO BOX 126 Low/High rate: 3,000/10,000 DEVELOPMENTALLY DISABLED County: MONROE WILTON WI 54670 Initial License: 03/25/2020 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY LIBERTY VILLAGE LLC (0013967) LIBERTY VILLAGE LLC Type: CBRF HCBS COMPLIANT (608) 498-2424 Class: CNA 200 LIBERTY PLACE ADVANCED AGED TOMAH WI 54660 ROBERT SIMONSON Gender - Capacity: M/F - 22 (608) 374-5005 ROBERT SIMONSON 2850 MONARCH COURT Low/High rate: 3,325/4,975 IRREVERSIBLE DEMENTIA/ALZHEIM County: MONROE ALTOONA WI 54720 Initial License: 12/01/2011 PHYSICALLY DISABLED PUBLIC FUNDING MEADOWS (THE) (0013299) MONROE COUNTY [ROLLING HILLS REHAB CEN Type: CBRF ADVANCED AGED (608) 269-8801 Class: CNA 14345 CTY HWY B IRREVERSIBLE DEMENTIA/ALZHEIM SPARTA WI 54656 LINDA SMITH Gender - Capacity: M/F - 8 (608) 269-8839 LINDA SMITH 14345 CTY HWY B Low/High rate: 3,400/4,100 County: MONROE SPARTA WI 54656 Initial License: 09/13/2010 Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 98 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

OAK ST HOUSE (0017351) WINDY RIDGE CARE INC Type: CBRF HCBS COMPLIANT (608) 343-1177 Class: AA 220 OAK ST ALCOHOL/DRUG DEPENDENT SPARTA WI 54656 GLORIA DIPPEN Gender - Capacity: M/F - 8 (608) 343-1177 GLORIA DIPPEN PO BOX 126 Low/High rate: 4,000/8,000 CORRECTIONAL CLIENTS County: MONROE WILTON WI 54670 Initial License: 12/21/2018 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY REM WALL STREET (0014512) REM WISCONSIN INC Type: CBRF HCBS COMPLIANT (608) 327-5945 Class: CNA 904 WALL STREET DEVELOPMENTALLY DISABLED CASHTON WI 54619 LORI WRIGHT Gender - Capacity: M/F - 6 (608) 654-5731 TRACY PHILLIPS 4033 123rd ST, STE A Low/High rate: 5,262/7,118 PHYSICALLY DISABLED County: MONROE CHIPPEWA FALLS WI 54729 Initial License: 02/20/2013 PUBLIC FUNDING TRAUMATIC BRAIN INJURY RIVER ROAD ESTATES LLC (0017281) RIVER ROAD ESTATES LLC Type: CBRF ADVANCED AGED (608) 269-8532 Class: CNA 1848 RIVER RD IRREVERSIBLE DEMENTIA/ALZHEIM SPARTA WI 54656 RYAN ZILLMER Gender - Capacity: M/F - 15 (608) 269-8532 RYAN ZILLMER 1848 RIVER RD Low/High rate: 2,500/3,500 PHYSICALLY DISABLED County: MONROE SPARTA WI 54656 Initial License: 08/31/2018 SUN HAVEN (0016485) SUN HAVEN LLC Type: CBRF ADVANCED AGED (608) 372-9670 Class: CS 20035 JUNCO RD DEVELOPMENTALLY DISABLED TOMAH WI 54660 HARRY OAKES Gender - Capacity: M/F - 8 (608) 372-9670 HARRY OAKES 20035 JUNCO RD Low/High rate: 2,400/3,400 EMOTIONALLY DISTURBED/MENTAL County: MONROE TOMAH WI 54660 Initial License: 03/01/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY TROWBRIDGE PERSONAL CARE RESIDENCE (510046) SHELLY TROWBRIDGE Type: CBRF EMOTIONALLY DISTURBED/MENTAL 110 E COUNCIL ST (608) 372-4388 Class: AA TOMAH WI 54660 SHELLY TROWBRIDGE Gender - Capacity: M - 8 (608) 372-4388 SHELLY TROWBRIDGE 110 E COUNCIL ST Low/High rate: 1,335/2,700 County: MONROE TOMAH WI 54660 Initial License: 01/04/1990 WARRENS HOUSE (0016507) WINDY RIDGE CARE INC Type: CBRF HCBS COMPLIANT (608) 343-1177 Class: AA 611 COLTON CT ALCOHOL/DRUG DEPENDENT WARRENS WI 54666 GLORIA DIPPEN Gender - Capacity: M/F - 6 (608) 378-3547 GLORIA DIPPEN PO BOX 126 Low/High rate: DEVELOPMENTALLY DISABLED County: MONROE WILTON WI 54670 Initial License: 05/02/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY WINDY RIDGE CARE INC HOLLISTER HOUSE (0017143) WINDY RIDGE CARE INC Type: CBRF HCBS COMPLIANT (608) 343-1177 Class: AA 325 HOLLISTER AVE ALCOHOL/DRUG DEPENDENT TOMAH WI 54660 GLORIA DIPPEN Gender - Capacity: M/F - 6 (608) 567-0203 GLORIA DIPPEN PO BOX 126 Low/High rate: 3,500/7,000 CORRECTIONAL CLIENTS County: MONROE WILTON WI 54670 Initial License: 06/11/2018 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY ASSISTED LIVING FOR LAKEWOOD LLC (0017693) ASSISTED LIVING BY HILLCREST Type: CBRF HCBS COMPLIANT (920) 850-5235 Class: CNA 17185 FLYNN LANE ADVANCED AGED LAKEWOOD WI 54138 JACQUELINE DEY Gender - Capacity: M/F - 20 (715) 276-1680 JACQUELINE DEY 1889 COMMERCE DR Low/High rate: 3,500/8,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OCONTO DEPERE WI 54115 Initial License: 07/11/2019 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 99 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CARE PARTNERS ASSISTED LIVING OCONTO (0016443) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 301 PINE AVE ADVANCED AGED OCONTO WI 54153 JASON E LINDEMANN Gender - Capacity: M/F - 25 (920) 232-1672 JOAN HUBACHER PO BOX 3006 Low/High rate: 3,900/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: OCONTO OSHKOSH WI 54903 Initial License: 10/27/2016 PHYSICALLY DISABLED TERMINALLY ILL COTTAGES AT MEADOWLANDS MEMORY CARE THE (001 COTTAGES AT MEADOWLANDS LLC THE Type: CBRF HCBS COMPLIANT (920) 846-4200 Class: CNA 747 E HIGHLAND DR IRREVERSIBLE DEMENTIA/ALZHEIM OCONTO FALLS WI 54154 CARA PETERSON Gender - Capacity: M/F - 20 (920) 846-4200 CARA PETERSON 747 E HIGHLAND DR Low/High rate: 5,160/6,210 PUBLIC FUNDING County: OCONTO OCONTO FALLS WI 54154 Initial License: 01/20/2015 Association Approval: WALA REM KING STREET (0015641) REM WISCONSIN II INC Type: CBRF HCBS COMPLIANT (715) 861-7377 Class: CNA 106 KING ST DEVELOPMENTALLY DISABLED OCONTO FALLS WI 54154 Lori Wright Gender - Capacity: M/F - 5 (920) 846-3287 DeAnna Dertz 4033 123rd Street Low/High rate: 7,470/8,418 EMOTIONALLY DISTURBED/MENTAL County: OCONTO Chippewa Falls WI 54729 Initial License: 05/01/2015 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY REM SUPERIOR (0015642) REM WISCONSIN II INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA 1204 SUPERIOR AVE DEVELOPMENTALLY DISABLED OCONTO WI 54153 LORI WRIGHT Gender - Capacity: M/F - 6 (920) 834-2292 DeAnna Dertz 4033 123 ST, STE A Low/High rate: 6,032/7,049 EMOTIONALLY DISTURBED/MENTAL County: OCONTO CHIPPEWA FALLS WI 54729 Initial License: 05/01/2015 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING SV NORTH NINE ACRES (0017750) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 229 VAN DYKE ST ADVANCED AGED OCONTO WI 54153 JEFFREY SEEGMILLER Gender - Capacity: M/F - 20 (920) 834-0302 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 2,400/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: OCONTO WITTENBERG WI 54499 Initial License: 10/01/2019 PHYSICALLY DISABLED TERMINALLY ILL SV NORTH OCONTO 1 (0017758) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 425 PECOR ST ADVANCED AGED OCONTO WI 54153 JEFFREY SEEGMILLER Gender - Capacity: M/F - 8 (920) 834-0302 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 2,600/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: OCONTO WITTENBERG WI 54499 Initial License: 10/01/2019 PHYSICALLY DISABLED TERMINALLY ILL SV NORTH OCONTO 2 (0017751) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 427 PECOR ST ADVANCED AGED OCONTO WI 54153 JEFFREY SEEGMILLER Gender - Capacity: M/F - 16 (920) 834-0302 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 2,600/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OCONTO WITTENBERG WI 54499 Initial License: 10/01/2019 PHYSICALLY DISABLED TERMINALLY ILL COUNTRY TERRACE MINOCQUA I (0015554) COUNTRY TERRACE OF WI INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 8730A PACKING PLANT RD ADVANCED AGED MINOCQUA WI 54548 JASON LINDEMANN Gender - Capacity: M/F - 14 (715) 356-1171 KRISTY BURKE PO BOX 3006 Low/High rate: 3,800/4,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: ONEIDA OSHKSOH WI 54903 Initial License: 09/11/2015 PHYSICALLY DISABLED TERMINALLY ILL COUNTRY TERRACE MINOCQUA II (0015552) COUNTRY TERRACE OF WIS INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 8730B PACKING PLANT RD ADVANCED AGED MINOCQUA WI 54548 JASON LINDEMANN Gender - Capacity: M/F - 10 (715) 439-4011 KRISTY BURKE PO BOX 3006 Low/High rate: 4,200/5,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: ONEIDA OSHKOSH WI 54903 Initial License: 09/22/2015 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 100 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

COUNTRY TERRACE OF WI INC 26 (0014050) COUNTRY TERRACE OF WI INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 533 E TIMBER DRIVE ADVANCED AGED RHINELANDER WI 54501 JASON LINDEMANN Gender - Capacity: M/F - 15 (715) 365-3324 ALISHA TATROW P O BOX 3006 Low/High rate: 3,000/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: ONEIDA OSHKOSH WI 54903 Initial License: 02/23/2012 PHYSICALLY DISABLED TERMINALLY ILL COUNTRY TERRACE RHINELANDER II (0014128) COUNTRY TERRACE OF WI INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1450 W PHILLIPS STREET ADVANCED AGED RHINELANDER WI 54501 JASON LINDEMANN Gender - Capacity: M/F - 15 (715) 362-0333 ALISHA TATROW P O BOX 3006 Low/High rate: 3,250/4,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: ONEIDA OSHKOSH WI 54903 Initial License: 04/05/2012 PHYSICALLY DISABLED TERMINALLY ILL HERITAGE HOUSE (0008500) FAMILY MATTERS INC Type: CBRF HCBS COMPLIANT (715) 369-1407 Class: AS 25 EAST FREDRICK STREET ADVANCED AGED RHINELANDER WI 54501 ELIZABETH MEYER Gender - Capacity: M/F - 8 (715) 369-1407 ELIZABETH MEYER PO BOX 304 Low/High rate: 2,500/3,500 ALCOHOL/DRUG DEPENDENT County: ONEIDA RHINELANDER WI 54501 Initial License: 07/26/1999 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM KOINONIA (0013977) OPTIONS COUNSELING SERVICES LLC Type: CBRF HCBS COMPLIANT (715) 362-5745 Class: AA 1991 WINNEBAGO DR ALCOHOL/DRUG DEPENDENT RHINELANDER WI 54501 BRUCE DECORAH Gender - Capacity: M/F - 35 (715) 362-5745 BRUCE DECORAH PO BOX 1550 Low/High rate: 3,258/6,120 CORRECTIONAL CLIENTS County: ONEIDA RHINELANDER WI 54501 Initial License: 01/01/2012 EMOTIONALLY DISTURBED/MENTAL PREGNANT WOMEN/COUNSELLING PUBLIC FUNDING LAKE SHORE ASSISTED LIVING LAKE TOMAHAWK (00164 LAKE SHORE ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 331-9148 Class: CNA 6416 FLICKER RD ADVANCED AGED LAKE TOMAHAWK WI 54539 HEATHER FISHLEIGH Gender - Capacity: M/F - 16 (715) 277-2010 HEATHER FISHLEIGH 12440 WARPATH LN Low/High rate: 3,100/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: ONEIDA MINOCQUA WI 54548 Initial License: 01/09/2017 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY MILESTONE SENIOR LIVING ELM CBRF (0017060) ABILIT HOLDINGS WOODRUFF LLC Type: CBRF ADVANCED AGED (858) 500-6793 Class: CNA 750 ELM ST IRREVERSIBLE DEMENTIA/ALZHEIM WOODRUFF WI 54568 AMY LEMKE Gender - Capacity: M/F - 22 (715) 439-4024 AMY LEMKE 208 35TH ST DR SE STE 500 Low/High rate: 5,700/6,975 County: ONEIDA CEDAR RAPIDS IA 52403-1361 Initial License: 05/18/2018 AGAPE 2 SILVER SPUR (410537) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: AA 15 SILVER SPUR DEVELOPMENTALLY DISABLED APPLETON WI 54915 DAN WITT Gender - Capacity: F - 8 (920) 731-7010 COURTNEY ROSS 7 TRI-PARK WAY Low/High rate: 4,294/4,294 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 01/01/1998 PUBLIC FUNDING AGAPE 2 SILVER SPUR (410537) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: AA 15 SILVER SPUR DEVELOPMENTALLY DISABLED APPLETON WI 54915 DAN WITT Gender - Capacity: F - 8 (920) 731-7010 COURTNEY ROSS 7 TRI-PARK WAY Low/High rate: 4,294/4,294 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 01/01/1998 PUBLIC FUNDING AGAPE 3 - 12TH ST (410039) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CS 412 E 12TH ST DEVELOPMENTALLY DISABLED KAUKAUNA WI 54130 DAN WITT Gender - Capacity: M/F - 7 (920) 766-9776 TERRY FRIEDERS 7 TRI-PARK WAY Low/High rate: 6,387/6,387 PUBLIC FUNDING County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 11/01/1986 AGAPE 3 - 12TH ST (410039) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CS 412 E 12TH ST DEVELOPMENTALLY DISABLED KAUKAUNA WI 54130 DAN WITT Gender - Capacity: M/F - 7 (920) 766-9776 TERRY FRIEDERS 7 TRI-PARK WAY Low/High rate: 6,387/6,387 PUBLIC FUNDING County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 11/01/1986

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 101 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

AGAPE 3 - 12TH ST (410039) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CS 412 E 12TH ST DEVELOPMENTALLY DISABLED KAUKAUNA WI 54130 DAN WITT Gender - Capacity: M/F - 7 (920) 766-9776 TERRY FRIEDERS 7 TRI-PARK WAY Low/High rate: 6,387/6,387 PUBLIC FUNDING County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 11/01/1986 AGAPE 3 - 12TH ST (410039) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CS 412 E 12TH ST DEVELOPMENTALLY DISABLED KAUKAUNA WI 54130 DAN WITT Gender - Capacity: M/F - 7 (920) 766-9776 TERRY FRIEDERS 7 TRI-PARK WAY Low/High rate: 6,387/6,387 PUBLIC FUNDING County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 11/01/1986 Association Approval: DSPN AGAPE 4 - GREENFIELD (410044) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CA 343 E GREENFIELD ST DEVELOPMENTALLY DISABLED APPLETON WI 54911 DAN WITT Gender - Capacity: M/F - 8 (920) 733-4891 SCOTT JOHNSON 7 TRI-PARK WAY Low/High rate: 4,218/4,218 PUBLIC FUNDING County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 01/24/1988 AGAPE 4 - GREENFIELD (410044) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CA 343 E GREENFIELD ST DEVELOPMENTALLY DISABLED APPLETON WI 54911 DAN WITT Gender - Capacity: M/F - 8 (920) 733-4891 SCOTT JOHNSON 7 TRI-PARK WAY Low/High rate: 4,218/4,218 PUBLIC FUNDING County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 01/24/1988 AGAPE 6 MOASIS (0018218) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CNA 425 MOASIS DRIVE DEVELOPMENTALLY DISABLED LITTLE CHUTE WI 54140 DANIEL WITT Gender - Capacity: M/F - 8 (920) 687-5080 STEPHANIE DEBROKA 7 TRI PARK WAY Low/High rate: 5,100/6,000 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE APPLETON WI 54914 Initial License: 10/15/2020 PHYSICALLY DISABLED AGAPE 7 FIELDCREST (410189) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CNA 3003 FIELDCREST DEVELOPMENTALLY DISABLED KAUKAUNA WI 54130 DAN WITT Gender - Capacity: M/F - 8 (920) 766-0516 FELICIA MENDOZA 7 TRI-PARK WAY Low/High rate: 5,975/5,975 PHYSICALLY DISABLED County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 11/20/1989 PUBLIC FUNDING AGAPE 7 FIELDCREST (410189) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CNA 3003 FIELDCREST DEVELOPMENTALLY DISABLED KAUKAUNA WI 54130 DAN WITT Gender - Capacity: M/F - 8 (920) 766-0516 FELICIA MENDOZA 7 TRI-PARK WAY Low/High rate: 5,975/5,975 PHYSICALLY DISABLED County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 11/20/1989 PUBLIC FUNDING AGAPE 7 FIELDCREST (410189) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CNA 3003 FIELDCREST DEVELOPMENTALLY DISABLED KAUKAUNA WI 54130 DAN WITT Gender - Capacity: M/F - 8 (920) 766-0516 FELICIA MENDOZA 7 TRI-PARK WAY Low/High rate: 5,975/5,975 PHYSICALLY DISABLED County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 11/20/1989 PUBLIC FUNDING Association Approval: DSPN AGAPE 8 CHEROKEE ST (410260) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: AA 2237 W CHEROKEE ST DEVELOPMENTALLY DISABLED APPLETON WI 54914 DAN WITT Gender - Capacity: M - 6 (920) 832-8198 NICHOLAS ZACH 7 TRI-PARK WAY Low/High rate: 5,031/5,031 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 06/14/1991 PUBLIC FUNDING AGAPE 8 CHEROKEE ST (410260) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: AA 2237 W CHEROKEE ST DEVELOPMENTALLY DISABLED APPLETON WI 54914 DAN WITT Gender - Capacity: M - 6 (920) 832-8198 NICHOLAS ZACH 7 TRI-PARK WAY Low/High rate: 5,031/5,031 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 06/14/1991 PUBLIC FUNDING AGAPE 9 KINGFISHER (410380) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CNA N500 KINGFISHER CT ADVANCED AGED APPLETON WI 54915 DAN WITT Gender - Capacity: M/F - 8 (920) 687-0522 SARAH HIPPERT 7 TRI-PARK WAY Low/High rate: 5,474/5,474 DEVELOPMENTALLY DISABLED County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 09/01/1995 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 102 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

AGAPE 9 KINGFISHER (410380) AGAPE OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 734-9871 Class: CNA N500 KINGFISHER CT ADVANCED AGED APPLETON WI 54915 DAN WITT Gender - Capacity: M/F - 8 (920) 687-0522 SARAH HIPPERT 7 TRI-PARK WAY Low/High rate: 5,474/5,474 DEVELOPMENTALLY DISABLED County: OUTAGAMIE APPLETON WI 54914-1661 Initial License: 09/01/1995 PUBLIC FUNDING Association Approval: WALA APPLE CREEK PLACE I (0017916) PPRC LLC Type: CBRF HCBS COMPLIANT (319) 340-4863 Class: CNA 5102 N CHERRYVALE AVENUE ADVANCED AGED APPLETON WI 54913 KAREN SCHACHT Gender - Capacity: M/F - 22 (920) 735-6166 KAREN SCHACHT 328 NATURE PL Low/High rate: 3,900/7,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE JOHNSON CREEK WI 53038 Initial License: 03/19/2020 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL APPLE CREEK PLACE II (0017917) PPRC LLC Type: CBRF HCBS COMPLIANT (319) 340-4863 Class: CNA 5118 CHERRYVALE AVENUE ADVANCED AGED APPLETON WI 54913 KAREN SCHACHT Gender - Capacity: M/F - 22 (920) 735-6166 KAREN SCHACHT 328 NATURE PL Low/High rate: 3,900/7,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE JOHNSON CREEK WI 53038 Initial License: 03/19/2020 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL APPLE CREEK PLACE III (0017918) PPRC LLC Type: CBRF HCBS COMPLIANT (319) 340-4863 Class: CNA 5117 N CHERRYVALE AVENUE ADVANCED AGED APPLETON WI 54913 KAREN SCHACHT Gender - Capacity: M/F - 22 (920) 735-6166 KAREN SCHACHT 328 NATURE PL Low/High rate: 3,950/7,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE JOHNSON CREEK WI 53038 Initial License: 02/04/2020 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL APPLE VALLEY (0009551) BROTOLOC HEALTH CARE SYSTEMS INC DBA B Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA 2214 RUSSET CT DEVELOPMENTALLY DISABLED APPLETON WI 54914 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 6 (920) 993-9678 LINDSAY FARRELL-GOVEK PO BOX 400 Low/High rate: 5,673/6,262 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE HORTONVILLE WI 54944 Initial License: 04/24/2002 PUBLIC FUNDING TRAUMATIC BRAIN INJURY AQUA VIEW (410266) BROTOLOC HEALTH CARE SYSTEMS INC DBA B Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA BOX 400 W9449 GIVENS RD DEVELOPMENTALLY DISABLED HORTONVILLE WI 54944 Lindsay Farrell-Govek Gender - Capacity: M/F - 8 (920) 779-3902 LINDSAY FARRELL-GOVEK 2710 N Town Hall Road Low/High rate: 6,161/6,161 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE Eau Claire WI 54703 Initial License: 07/01/1991 PUBLIC FUNDING TRAUMATIC BRAIN INJURY ASPIRE SENIOR LIVING (0016636) HSL 14 LLC Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA 825 COBBLESTONE LN ADVANCED AGED KIMBERLY WI 54136 MILO PINKERTON Gender - Capacity: M/F - 83 (920) 720-0288 JUSTIN EDWARDS GERBERS 7901 W NATIONAL AVE Low/High rate: 4,890/8,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE WEST ALLIS WI 53214 Initial License: 08/08/2017 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL BIRCH WAY (0013858) GOOD SHEPHERD SERVICES LTD Type: CBRF ADVANCED AGED (920) 833-6856 Class: CNA 607 E BRONSON RD IRREVERSIBLE DEMENTIA/ALZHEIM SEYMOUR WI 54165 DEBORAH CAPTAIN Gender - Capacity: M/F - 20 (920) 833-6856 DEBORAH CAPTAIN 607 E BRONSON RD Low/High rate: 4,500/5,350 PHYSICALLY DISABLED County: OUTAGAMIE SEYMOUR WI 54165 Initial License: 06/27/2012 PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin CARE PARTNERS ASSISTED LIVING HORTONVILLE (0016 CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 112 HARRIS WAY ADVANCED AGED HORTONVILLE WI 54944 JASON LINDEMANN Gender - Capacity: M/F - 56 (920) 232-1672 BRENDA HOFFMANN PO BOX 3006 Low/High rate: 4,500/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE OSHKOSH WI 54903 Initial License: 10/24/2017 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 103 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CARE PARTNERS ASSISTED LIVING I (0016352) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 5031 N FRENCH RD ADVANCED AGED APPLETON WI 54913 JASON LINDEMANN Gender - Capacity: M/F - 20 (920) 903-8325 RHONDA PINGEL PO BOX 3006 Low/High rate: 4,700/5,600 DEVELOPMENTALLY DISABLED County: OUTAGAMIE OSHKOSH WI 54903 Initial License: 09/14/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL CARE PARTNERS ASSISTED LIVING II (0016353) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 5101 N FRENCH RD ADVANCED AGED APPLETON WI 54913 JASON LINDEMANN Gender - Capacity: M/F - 38 (920) 939-2020 RHONDA PINGEL PO BOX 3006 Low/High rate: 4,500/7,000 DEVELOPMENTALLY DISABLED County: OUTAGAMIE OSHKOSH WI 54903 Initial License: 09/14/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL CAROLINA ASSISTED LIVING (0018091) ARMH LEASECO 1 LLC Type: CBRF HCBS COMPLIANT (858) 500-6793 Class: CNA 3201 WEST 1ST AVENUE ADVANCED AGED APPLETON WI 54914 KAREN SCHACHT Gender - Capacity: M/F - 45 (920) 710-1427 BAYLEE DRUMMOND 328 NATURE PL Low/High rate: 4,295/6,295 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE JOHNSON CREEK WI 53038 Initial License: 05/27/2020 CASA CLARE A DIVISION OF MOORING PROGRAM INC (0 MOORING PROGRAMS INC Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 739-3235 Class: AA 201 S GLENRIDGE CT PUBLIC FUNDING APPLETON WI 54914 JOLIE VERVOORT Gender - Capacity: F - 20 (920) 731-3981 JOLIE VERVOORT 607 W SEVENTH ST Low/High rate: 4,284/4,743 County: OUTAGAMIE APPLETON WI 54911 Initial License: 03/03/2006 CENTURY OAKS OF APPLETON (0016347) CENTURY OAKS HOMES Type: CBRF HCBS COMPLIANT (920) 915-1076 Class: CNA 2302 EAST GLENHURST ADVANCED AGED APPLETON WI 54913 PAUL MORAN Gender - Capacity: M/F - 87 ALYSSA TIETZ PO BOX 421 Low/High rate: 4,500/10,000 DEVELOPMENTALLY DISABLED County: OUTAGAMIE NEENAH WI 54957 Initial License: 08/30/2016 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CENTURY OAKS ON BALLARD (0015583) CENTURY OAKS OF APPLETON INC Type: CBRF HCBS COMPLIANT (920) 915-1076 Class: CNA 2100 E GLENHURST LN ADVANCED AGED APPLETON WI 54913 PAUL MORAN Gender - Capacity: - 67 ALYSSA TIETZ PO BOX 421 Low/High rate: 4,300/9,700 DEVELOPMENTALLY DISABLED County: OUTAGAMIE NEENAH WI 54957 Initial License: 05/29/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CLOVERDALE (0014320) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 1825 CLOVERDALE DR ADVANCED AGED APPLETON WI 54914 BARB SALEMI Gender - Capacity: M/F - 6 (920) 609-2784 TRACY ROTH 424 WASHINGTON AVE Low/High rate: 4,835/4,835 DEVELOPMENTALLY DISABLED County: OUTAGAMIE OSHKOSH WI 54901 Initial License: 08/29/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY COUNTRY TERRACE APPLETON (0009664) COUNTRY TERRACE OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 749 W PARKWAY BLVD ADVANCED AGED APPLETON WI 54914 JASON LINDEMANN Gender - Capacity: M/F - 16 (920) 830-3285 TYSHAWN BUTLER PO BOX 3006 Low/High rate: 2,600/3,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE OSHKOSH WI 54903-3006 Initial License: 11/21/2002 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 104 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

COUNTRY VILLA ASSISTED LIVING 1 INC (0015056) COUNTRY VILLA ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 213-4437 Class: CNA N3782 COUNTRY VILLA WAY ADVANCED AGED FREEDOM WI 54913 CHAD READER Gender - Capacity: M/F - 38 (920) 422-4620 BRIANA SKORUPSKI W4684 E NICHOLS RD Low/High rate: 4,000/8,000 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE SEYMOUR WI 54165 Initial License: 06/01/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL DELLVIEW (410293) BROTOLOC HEALTH CARE SYSTEMS INC DBA B Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA N2784 HWY 15 DEVELOPMENTALLY DISABLED HORTONVILLE WI 54944 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 8 (920) 779-3905 LINDSAY FARRELL-GOVEK PO BOX 400 Low/High rate: 6,330/6,541 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE HORTONVILLE WI 54944 Initial License: 03/01/1992 PUBLIC FUNDING TRAUMATIC BRAIN INJURY DIMENSIONS LIVING APPLETON (0015133) S-H OPCO FOX RIVER LLC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 5800 PENNSYLVANIA AVE ADVANCED AGED APPLETON WI 54915 LEXIE BAUM Gender - Capacity: M/F - 95 (920) 243-0367 JADERIAN WILLIAMS 12900 WHITEWATER DR STE 201 Low/High rate: 3,395/4,995 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE MINNEAPOLIS MN 55343 Initial License: 08/29/2014 PUBLIC FUNDING EAGLE COURT MEMORY CARE (0018098) EAGLE COURT MEMORY CARE INC Type: CBRF HCBS COMPLIANT (608) 664-3500 Class: CNA 975 EAST JOHN STREET ADVANCED AGED APPLETON WI 54911 JENNIFER THOMPSON Gender - Capacity: M/F - 28 (920) 843-9466 JENNIFER THOMPSON 975 EAST JOHN STREET Low/High rate: 5,150/5,150 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE APPLETON WI 54911 Initial License: 09/21/2020 Association Approval: WiCAL FIELDSTONE HOUSE (0009276) BROTOLOC HEALTH CARE SYSTEMS INC DBA B Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA 495 W NYE ST DEVELOPMENTALLY DISABLED HORTONVILLE WI 54944 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 6 (920) 779-0712 LINDSAY FARRELL-GOVEK PO BOX 400 Low/High rate: 5,873/6,068 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE HORTONVILLE WI 54944-0400 Initial License: 05/22/2001 PUBLIC FUNDING TRAUMATIC BRAIN INJURY FOX HOLLOW (0014721) INNOVATIVE SERVICES INC Type: CBRF HCBS COMPLIANT (920) 431-0962 Class: CNA W7126 FOX HOLLOW ADVANCED AGED GREENVILLE WI 54942 JILL ROWLAND Gender - Capacity: M/F - 8 (920) 364-9515 HEIDI HIETPAS 2321 SAN LUIS PLACE Low/High rate: 5,636/5,757 DEVELOPMENTALLY DISABLED County: OUTAGAMIE GREEN BAY WI 54304 Initial License: 08/21/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY FRONTIDA ASSISTED LIVING OF KIMBERLY I (0016997) LIBERTY FRONTIDA INC Type: CBRF HCBS COMPLIANT (262) 308-3839 Class: CNA 820 SCHELFHOUT LANE ADVANCED AGED KIMBERLY WI 54136 CARIN SCHULTZ Gender - Capacity: M/F - 22 (920) 788-2300 ALANA PARENT 702 57TH STREET 2ND FLOOR Low/High rate: 4,400/8,400 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE KENOSHA WI 53140 Initial License: 11/29/2017 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA FRONTIDA ASSISTED LIVING OF KIMBERLY II (0016998) LIBERTY FRONTIDA INC Type: CBRF HCBS COMPLIANT (262) 308-3839 Class: CNA 816 SCHELFHOUT LANE ADVANCED AGED KIMBERLY WI 54136 CARIN SCHULTZ Gender - Capacity: M/F - 26 (920) 788-2300 ALANA PARENT 702 57TH STREET 2ND FLOOR Low/High rate: 4,400/8,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE KENOSHA WI 53140 Initial License: 11/29/2017 PUBLIC FUNDING Association Approval: WALA GOOD SHEPHERD SERVICES DBA FOREST GLEN CBRF ( GOOD SHEPHERD SERVICES LTD Type: CBRF HCBS COMPLIANT (920) 833-6856 Class: CNA 721 BRONSON RD ADVANCED AGED SEYMOUR WI 54165 DEBORAH CAPTAIN Gender - Capacity: M/F - 20 (920) 833-6856 DEBORAH CAPTAIN 607 E BRONSON RD Low/High rate: 4,500/5,350 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE SEYMOUR WI 54165 Initial License: 12/15/2014 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 105 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HEARTWOOD HOMES SENIOR LIVING INC III (0011054) HEARTWOOD HOMES SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 419-2490 Class: CNA 1407 N MASON ST ADVANCED AGED APPLETON WI 54914 JASON SCHMITZ Gender - Capacity: M/F - 18 (920) 955-3500 JASON SCHMITZ 1531 ELK TRAIL CT Low/High rate: 5,511/6,475 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE NEENAH WI 54956 Initial License: 10/27/2005 HEARTWOOD HOMES SENIOR LIVING INC IV (0012559) HEARTWOOD HOMES SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 419-2490 Class: CNA 1413 N MASON STREET ADVANCED AGED APPLETON WI 54914 JASON SCHMITZ Gender - Capacity: M/F - 20 (920) 955-3800 JASON SCHMITZ 1531 ELK TRAIL CT Low/High rate: 4,400/6,850 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE NEENAH WI 54956 Initial License: 11/03/2008 PHYSICALLY DISABLED KIMBERLY PLACE (0010891) PRODUCTIVE LIVING SYSTEMS INC Type: CBRF HCBS COMPLIANT (920) 738-5393 Class: AA 314 W KIMBERLY AVE DEVELOPMENTALLY DISABLED KIMBERLY WI 54136 JENNY MAYVILLE Gender - Capacity: M/F - 8 (920) 687-1198 JENNY MAYVILLE 619 N LYNNDALE DRIVE Low/High rate: 6,062/6,062 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE APPLETON WI 54914 Initial License: 04/27/2005 TRAUMATIC BRAIN INJURY KINDREDHEARTS KAUKAUNA (0009721) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 548 FRANCES ST ADVANCED AGED KAUKAUNA WI 54130 SUE LEY Gender - Capacity: M/F - 16 (920) 766-4455 ASHLEY VAN ERT 548 FRANCES ST Low/High rate: 3,565/3,781 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE KAUKAUNA WI 54130 Initial License: 10/02/2002 PUBLIC FUNDING KINDREDHEARTS OF GREENVILLE (0013792) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA W7098 BUTTERCUP CT ADVANCED AGED GREENVILLE WI 54942 DOUGLAS HENNIG Gender - Capacity: M/F - 17 (920) 757-0996 DOUG HENNIG 555 COMMERCIAL AVE/PO BOX 129 Low/High rate: 3,700/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE GREEN LAKE WI 54941 Initial License: 01/27/2012 PUBLIC FUNDING KLISTER HOUSE (410040) VILLA PHOENIX INC Type: CBRF HCBS COMPLIANT (920) 731-1316 Class: AA 408 N LAWE ST ALCOHOL/DRUG DEPENDENT APPLETON WI 54911 ANN LUX Gender - Capacity: M - 5 (920) 733-5580 ANN LUX PO BOX 303 Low/High rate: 3,531/4,980 CORRECTIONAL CLIENTS County: OUTAGAMIE APPLETON WI 54912 Initial License: 12/01/1983 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING LANDINGS OF KAUKAUNA (THE) (0016337) MS AC KAUKAUNA SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (240) 595-6065 Class: CNA 793 TARRAGON DRIVE ADVANCED AGED KAUKAUNA WI 54130 DAN CASTLEBERRY Gender - Capacity: M/F - 32 (920) 462-4018 CINDY GILLIS 6931 ARLINGTON ROAD SUITE 320 Low/High rate: 3,200/14,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE BETHESDA MD 20814 Initial License: 10/07/2016 PHYSICALLY DISABLED TERMINALLY ILL LANDINGS OF KAUKAUNA MC (THE) (0016336) MS AC KAUKAUNA SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (240) 595-6065 Class: CNA 795 TARRAGON DRIVE ADVANCED AGED KAUKAUNA WI 54130 DANIEL CASTLEBERRY Gender - Capacity: M/F - 26 (920) 759-0609 CINDY GILLIS 6931 ARLINGTON ROAD SUITE 320 Low/High rate: 2,850/14,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE BETHESDA MD 20814 Initial License: 10/07/2016 PHYSICALLY DISABLED TERMINALLY ILL LIVING TREE ESTATES LLC (0010721) LIVING TREE ESTATES LLC Type: CBRF HCBS COMPLIANT (920) 882-5045 Class: CNA N1916 GREENVILLE DRIVE ADVANCED AGED GREENVILLE WI 54942 JACQUELINE MARTIN Gender - Capacity: M/F - 47 (920) 882-5045 JACQUELINE MARTIN N1916 GREENVILLE DR Low/High rate: 4,684/7,667 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE GREENVILLE WI 54942 Initial License: 01/25/2005 Association Approval: WALA LSS EASTWOOD CRISIS FACILITY (0010046) LUTHERAN SOC SERV OF WI & UPPER MI INC Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 730-1351 Class: AA 430 S KENSINGTON DR EMOTIONALLY DISTURBED/MENTAL APPLETON WI 54915 BRENDA SKABROUD Gender - Capacity: M/F - 8 (920) 830-3376 BRENDA SKABROUD 830 EDGEWOOD DR Low/High rate: 6,772/6,772 PUBLIC FUNDING County: OUTAGAMIE GREEN BAY WI 54311 Initial License: 04/01/2003 LSS GRANDSTONE GROUP HOME (0010462) LUTHERAN SOC SERV OF WI & UPPER MI INC Type: CBRF HCBS COMPLIANT (920) 730-1337 Class: AA 1308 N LEONA ST EMOTIONALLY DISTURBED/MENTAL APPLETON WI 54911 PAULA UPP Gender - Capacity: M/F - 8 (920) 730-1028 DENNIS HANSON 3003-A N RICHMOND ST Low/High rate: 6,449/6,449 PUBLIC FUNDING County: OUTAGAMIE APPLETON WI 54911 Initial License: 03/11/2004

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 106 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MAYFLOWER ASSISTED LIVING LLC (0012699) MAYFLOWER ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (920) 991-9070 Class: CNA 140 S MAYFLOWER DRIVE EMOTIONALLY DISTURBED/MENTAL GRAND CHUTE WI 54914 MEGGAN PIERRE Gender - Capacity: M/F - 22 (920) 991-9070 MEGGAN PIERRE 140 S MAYFLOWER DR Low/High rate: 3,500/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE GRAND CHUTE WI 54914 Initial License: 02/01/2009 PHYSICALLY DISABLED TERMINALLY ILL MISTY ARBOR ASSISTED LIVING (0016451) MISTY ARBOR ASSISTED LIVING LLC Type: CBRF EMOTIONALLY DISTURBED/MENTAL (920) 939-2177 Class: ANA 333 MISTY LANE IRREVERSIBLE DEMENTIA/ALZHEIM APPLETON WI 54914 PATRICIA MANLEY Gender - Capacity: M/F - 16 (920) 570-9621 PATRICIA MANLEY 333 MISTY LANE Low/High rate: 2,700/7,000 PHYSICALLY DISABLED County: OUTAGAMIE APPLETON WI 54914 Initial License: 03/08/2017 TERMINALLY ILL MOORING PROGRAMS INC (410041) MOORING PROGRAMS INC Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 739-3235 Class: AA 607 W SEVENTH ST PUBLIC FUNDING APPLETON WI 54911 JOLIE VERVOORT Gender - Capacity: M - 19 (920) 739-3235 JOLIE VERVOORT 607 W SEVENTH ST Low/High rate: 4,500/4,500 County: OUTAGAMIE APPLETON WI 54911 Initial License: 11/01/1980 PRIMROSE MEMORY CARE OF APPLETON (0017081) APPLETON RETIREMENT LLC Type: CBRF ADVANCED AGED (605) 226-3300 Class: CNA 5717 MEADE ST IRREVERSIBLE DEMENTIA/ALZHEIM APPLETON WI 54913 MARK MCNEARY Gender - Capacity: M/F - 26 (608) 713-9576 SCOTT ROSS 815 N 2ND ST Low/High rate: 5,420/5,620 TERMINALLY ILL County: OUTAGAMIE ABERDEEN SD 57401 Initial License: 09/19/2018 PROVINCE TERRACE VILLAS LONG CT LLC (0012777) PROVINCE TERRACE VILLAS LLC Type: CBRF HCBS COMPLIANT (920) 257-2573 Class: CNA 5216 LONG CT ADVANCED AGED APPLETON WI 54914 ROXANNE REEVES Gender - Capacity: M/F - 8 (920) 257-2573 ROXANNE REEVES 5216 LONG CT Low/High rate: 2,800/4,500 DEVELOPMENTALLY DISABLED County: OUTAGAMIE APPLETON WI 54914 Initial License: 10/28/2009 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ROGERS (0014325) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 1719 ROGERS ST ADVANCED AGED APPLETON WI 54914 BARB SALEMI Gender - Capacity: M/F - 6 (920) 642-3985 TRACY ROTH 424 WASHINGTON AVE Low/High rate: 5,970/6,235 DEVELOPMENTALLY DISABLED County: OUTAGAMIE OSHKOSH WI 54901 Initial License: 08/30/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY RUSSET (0014323) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (390) 236-6560 Class: CNA 2210 RUSSET CT ADVANCED AGED APPLETON WI 54911 BARB SALEMI Gender - Capacity: M - 7 (920) 469-5240 TRACY ROTH 424 WASHINGTON AVE Low/High rate: 4,820/5,292 DEVELOPMENTALLY DISABLED County: OUTAGAMIE OSHKOSH WI 54901 Initial License: 08/29/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY RYAN COMMUNITY INC (0017565) RYAN COMMUNITY INC Type: CBRF HCBS COMPLIANT (920) 731-3768 Class: AA 913 S WEST AVE CORRECTIONAL CLIENTS APPLETON WI 54915 JOSEPH WILZ Gender - Capacity: M - 21 (920) 731-3768 JOSEPH WILZ 913 S WEST AVE Low/High rate: 2,596/2,682 County: OUTAGAMIE APPLETON WI 54915 Initial License: 07/08/2019

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 107 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SHEPHERDS INN (0013175) GOOD SHEPHERDS SERVICES LTD Type: CBRF HCBS COMPLIANT (920) 833-6856 Class: CNA 621 W FACTORY ST ADVANCED AGED SEYMOUR WI 54165 DEBORAH CAPTAIN Gender - Capacity: M/F - 20 (920) 833-6856 DEBORAH CAPTAIN 607 E BRONSON RD Low/High rate: 2,777/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE SEYMOUR WI 54165 Initial License: 01/26/2010 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin SILVERSTONE MEMORY CARE INC (0018316) SILVERSTONE MEMORY CARE INC Type: CBRF ADVANCED AGED (715) 498-4949 Class: CNA 5100 SCHROTH LANE IRREVERSIBLE DEMENTIA/ALZHEIM GRAND CHUTE WI 54913 JESSICA SCHMIDT Gender - Capacity: M/F - 44 (715) 498-4949 JESSICA SCHMIDT 5100 SCHROTH LANE Low/High rate: 3,000/7,000 TERMINALLY ILL County: OUTAGAMIE GRAND CHUTE WI 54913 Initial License: 03/25/2021 ST PAUL MANOR (0016072) ST PAUL ELDER SERVICES INC Type: CBRF HCBS COMPLIANT () - Class: CNA 316 E 14TH ST IRREVERSIBLE DEMENTIA/ALZHEIM KAUKAUNA WI 54130 SONDRA NORDER Gender - Capacity: M/F - 24 (920) 766-6020 MORGAN HINKLEY 316 E 14TH ST Low/High rate: 0/5,890 PUBLIC FUNDING County: OUTAGAMIE KAUKAUNA WI 54130 Initial License: 07/01/2016 Association Approval: LeadingAge Wisconsin SYLVAN VIEW (410275) BROTOLOC HEALTH CARE SYSTEMS INC DBA B Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AA W9405 GIVENS RD DEVELOPMENTALLY DISABLED HORTONVILLE WI 54944 LINDSAY FARRELL-GOVEK Gender - Capacity: M/F - 8 (920) 779-3910 LINDSAY FARRELL-GOVEK PO BOX 400 Low/High rate: 6,154/6,154 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE HORTONVILLE WI 54944 Initial License: 08/01/1991 PUBLIC FUNDING TRAUMATIC BRAIN INJURY VAN DYKE (0014137) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 1811 S VAN DYKE RD ADVANCED AGED APPLETON WI 54914 BARB SALEMI Gender - Capacity: M - 8 (920) 236-6560 TRACY ROTH 424 WASHINGTON AVE Low/High rate: 4,440/5,938 DEVELOPMENTALLY DISABLED County: OUTAGAMIE OSHKOSH WI 54901 Initial License: 08/08/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY VILLA HOPE (410105) VILLA HOPE INC Type: CBRF HCBS COMPLIANT (920) 739-5337 Class: AS 613 N DIVISION ST DEVELOPMENTALLY DISABLED APPLETON WI 54911 BILL DRISCOLL Gender - Capacity: M - 15 (920) 739-5337 BILL DRISCOLL PO BOX 1733 Low/High rate: 2,034/3,906 EMOTIONALLY DISTURBED/MENTAL County: OUTAGAMIE APPLETON WI 54913 Initial License: 10/22/1981 TRAUMATIC BRAIN INJURY VILLA PHOENIX (410046) VILLA PHOENIX INC Type: CBRF HCBS COMPLIANT (920) 731-1316 Class: AA 418 N LAWE ST ALCOHOL/DRUG DEPENDENT APPLETON WI 54911 ANN LUX Gender - Capacity: M - 17 (920) 731-1316 ANN LUX PO BOX 303 Low/High rate: 3,990/4,123 CORRECTIONAL CLIENTS County: OUTAGAMIE APPLETON WI 54912 Initial License: 08/12/1980 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING WILLOW LANE ASSISTED LIVING (0014950) WILLOW LANE ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 716-0055 Class: CNA 850 W ELSNER RD ADVANCED AGED APPLETON WI 54913 KIM HOFFMAN Gender - Capacity: M/F - 32 (920) 380-0511 BRENDA DUSSO E8297 KNAACK RD Low/High rate: 4,800/6,450 IRREVERSIBLE DEMENTIA/ALZHEIM County: OUTAGAMIE CLINTONVILLE WI 54929 Initial License: 05/06/2014 PHYSICALLY DISABLED PUBLIC FUNDING ANITAS GARDENS (0011800) BRIKAT ENTERPRISES LLC Type: CBRF HCBS COMPLIANT (262) 268-0264 Class: CNA 117 E VAN BUREN ADVANCED AGED PORT WASHINGTON WI 53074 NICHOLAS BENAVIDES Gender - Capacity: M/F - 19 (262) 268-9780 CHELSEA HAHN 902 S MAIN STREET Low/High rate: 3,400/5,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE SAUKVILLE WI 53080 Initial License: 03/13/2007 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 108 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs Association Approval: WALA ANITAS GARDENS OF GRAFTON (0014942) BRIKAT ENTERPRISES LLC Type: CBRF HCBS COMPLIANT (262) 302-0006 Class: CNA 1777 W HIGHLAND DR ADVANCED AGED GRAFTON WI 53024 NICHOLAS BENAVIDES Gender - Capacity: M/F - 24 (262) 268-9780 REBECA VANA 902 S MAIN STREET Low/High rate: 4,000/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE SAUKVILLE WI 53080 Initial License: 02/13/2014 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA BELGIUM GARDENS (0012459) SANDVIEW LLC Type: CBRF HCBS COMPLIANT (262) 873-0034 Class: CNA 432 S HERITAGE ST ADVANCED AGED BELGIUM WI 53004 MARY READ Gender - Capacity: M/F - 22 (262) 285-3660 MARY M READ 1698 AQUA VIEW CT Low/High rate: 4,550/5,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE CEDARBURG WI 53012-9146 Initial License: 08/01/2008 PHYSICALLY DISABLED TERMINALLY ILL CNC FAMILY LIVING LLC DBA DEKORA SPRINGS (001361 CNC FAMILY LIVING LLC Type: CBRF HCBS COMPLIANT (920) 912-0999 Class: CNA 214 W DEKORA ST ADVANCED AGED SAUKVILLE WI 53080 CRAIG NICHELSON Gender - Capacity: M/F - 7 (262) 268-8234 CRAIG NICHELSON 214 W DEKORA ST Low/High rate: 3,500/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE SAUKVILLE WI 53080 Initial License: 06/01/2011 PHYSICALLY DISABLED TERMINALLY ILL CORNERSTONE GROUP HOME (0012525) INDIVIDUAL GROWTH SERVICES INC Type: CBRF HCBS COMPLIANT (262) 284-9656 Class: CNA 1521 W 2ND AVE DEVELOPMENTALLY DISABLED PORT WASHINGTON WI 53074 MELANIE CLAUSING Gender - Capacity: M/F - 8 (262) 284-9656 MELANIE CLAUSING 1000 N WISCONSIN ST ST 5 Low/High rate: 3,893/5,019 EMOTIONALLY DISTURBED/MENTAL County: OZAUKEE PORT WASHINGTON WI 53074 Initial License: 09/23/2008 ELLENS HOME PORT WASHINGTON (0012363) ELLENS HOME OF PORT WASHINGTON LLC Type: CBRF HCBS COMPLIANT (414) 531-2672 Class: CNA 1800 GRANITE RD ADVANCED AGED PORT WASHINGTON WI 53074 BONNIE SANFELIPPO Gender - Capacity: M/F - 44 (262) 268-9555 BONNIE SANFELIPPO 4780 BIRCHWOOD TRAIL Low/High rate: 4,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE WEST BEND WI 53095 Initial License: 09/09/2008 PUBLIC FUNDING EVELYN'S CBRF (0016595) EVELYN'S INC Type: CBRF ADVANCED AGED (262) 689-3088 Class: CNA 336 MICHAEL COURT DEVELOPMENTALLY DISABLED PORT WASHINGTON WI 53074 DEBORAH PAAPE Gender - Capacity: M/F - 8 (262) 284-6768 DEBORAH PAAPE PO BOX 219 Low/High rate: 3,000/3,200 PHYSICALLY DISABLED County: OZAUKEE FREDONIA WI 53021 Initial License: 08/02/2017 PUBLIC FUNDING FOREST HAVEN (0015119) FOREST HAVEN LLC Type: CBRF HCBS COMPLIANT () - Class: CNA 400 MARTIN DR ADVANCED AGED FREDONIA WI 53021 TRACY BARDWELL Gender - Capacity: M/F - 24 (262) 447-2113 KAREN TUTTLE 400 MARTIN DR Low/High rate: 4,000/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE FREDONIA WI 53021 Initial License: 09/15/2014 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL HAMBURG HOME (310406) FAMILY TREE RESIDENTIAL FAC INC Type: CBRF HCBS COMPLIANT (262) 375-0661 Class: CS 1951 FIRST AVE ADVANCED AGED GRAFTON WI 53024 DEBRA MCDANIEL Gender - Capacity: M/F - 12 (262) 375-1325 DEBRA MCDANIEL W63 N543 HANOVER AVE Low/High rate: 3,262/5,040 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE CEDARBURG WI 53012 Initial License: 07/01/1988 PUBLIC FUNDING HAMILTON HOUSE SENIOR LIVING INC (0017501) HAMILTON HOUSE SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (952) 888-2923 Class: CNA W76 N629 WAUWATOSA RD ADVANCED AGED CEDARBURG WI 53012 ALLAN BARR Gender - Capacity: M/F - 28 (262) 421-5551 CHRISTINE STOFLET W76 N629 WAUWATOSA RD Low/High rate: 4,900/5,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE CEDARBURG WI 53012 Initial License: 04/09/2019 PUBLIC FUNDING Association Approval: WiCAL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 109 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HARBOR COVE I CBRF (0016553) CAPRI COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (262) 798-1224 Class: CNA 333 W WALTERS ST ADVANCED AGED PORT WASHINGTON WI 53024 GLEN CHOBAN Gender - Capacity: M/F - 50 (262) 268-1800 CARLA KOSTECKI 20875 Crossroads Cir Suite 400 Low/High rate: 5,500/7,000 DEVELOPMENTALLY DISABLED County: OZAUKEE WAUKESHA WI 53186 Initial License: 03/01/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL HARBOR COVE II MEMORY CARE (0016552) CAPRI COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (262) 798-1224 Class: CNA 333 W WALTERS ST ADVANCED AGED PORT WASHINGTON WI 53024 GLEN CHOBAN Gender - Capacity: M/F - 20 (262) 268-1800 CARLA KOSTECKI 20875 Crossroads Cir Suite 400 Low/High rate: 5,500/7,500 DEVELOPMENTALLY DISABLED County: OZAUKEE WAUKESHA WI 53186 Initial License: 03/01/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL HARRISON HOME (310409) FAMILY TREE RESIDENTIAL FAC INC Type: CBRF HCBS COMPLIANT (262) 375-0661 Class: CNA W72 N675 HARRISON AVE ADVANCED AGED CEDARBURG WI 53012 DEBRA MCDANIEL Gender - Capacity: M/F - 15 (262) 375-0661 DEBRA MCDANIEL W63N543 HANDOVER AVE Low/High rate: 3,715/5,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE CEDARBURG WI 53012 Initial License: 03/01/1995 HIGHLAND (0014294) INDIVIDUAL GROWTH SERVICES Type: CBRF HCBS COMPLIANT (262) 284-9656 Class: AA 3987 HIGHLAND DR DEVELOPMENTALLY DISABLED PORT WASHINGTON WI 53074 MATTHEW NUERNBERG Gender - Capacity: M/F - 5 (262) 284-8896 MATTHEW NUERNBERG 1000 N WISCONSIN ST STE 5 Low/High rate: 4,239/4,239 PUBLIC FUNDING County: OZAUKEE PORT WASHINGTON WI 53074 Initial License: 09/19/2012 HILLTOP VIEW OF FREDONIA INC (0014821) HILLTOP VIEW OF FREDONIA INC Type: CBRF HCBS COMPLIANT (262) 692-2828 Class: CNA 130 MEYER AVE ADVANCED AGED FREDONIA WI 53021 HEATHER STAUTZ Gender - Capacity: M/F - 7 (262) 692-2828 DEBRA A RICHARDS W3150 ELM LN Low/High rate: 2,879/3,720 DEVELOPMENTALLY DISABLED County: OZAUKEE SHEBOYGAN FALLS WI 53085 Initial License: 12/20/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY ICONICARE OF MEQUON LLC dba WRIGHT HOUSE MEM C ICONICARE OF MEQUON LLC Type: CBRF HCBS COMPLIANT (608) 664-3500 Class: CNA 6729 WEST MEQUON ROAD ADVANCED AGED MEQUON WI 53092 KATHERINE DIERKSMEIER Gender - Capacity: M/F - 40 (262) 512-8060 KATHERINE DIERKSMEIER 6729 WEST MEQUON ROAD Low/High rate: 6,400/7,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE MEQUON WI 53092 Initial License: 03/23/2017 PUBLIC FUNDING Association Approval: WiCAL LINCOLN VILLAGE (0015962) HSL 3 LLC Type: CBRF HCBS COMPLIANT (414) 302-9700 Class: CNA 1330 W LINCOLN AVE ADVANCED AGED PORT WASHINGTON WI 53074 MILO PINKERTON Gender - Capacity: M/F - 42 (414) 964-7678 LESLIE HYLAND 7901 W NATIONAL AVE Low/High rate: 3,100/8,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE WEST ALLIS WI 53214 Initial License: 01/19/2016 PUBLIC FUNDING LUTHER MANOR AT RIVER OAKS (0009128) UNITED LUTHERAN PROGRAM FOR THE AGING Type: CBRF HCBS COMPLIANT (414) 464-3880 Class: CNA 11340 N CEDARBURG RD ADVANCED AGED MEQUON WI 53092 JULIE JOLITZ Gender - Capacity: M/F - 16 (262) 242-6660 LORIE MAECHTLE 4545 N 92ND ST Low/High rate: 5,370/6,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE WAUWATOSA WI 53225 Initial License: 10/11/2000 PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: LeadingAge Wisconsin MAGNOLIA HILL (0016249) STONE HILL GRAFTON LLC Type: CBRF ADVANCED AGED (414) 763-7869 Class: CNA 1706 WASHINGTON ST DEVELOPMENTALLY DISABLED GRAFTON WI 53024 JIM ZACHE Gender - Capacity: M/F - 20 (262) 377-2250 Zache Jim 314 E MAIN ST Low/High rate: 4,284/5,200 EMOTIONALLY DISTURBED/MENTAL County: OZAUKEE WATERTOWN WI 53094 Initial License: 09/01/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 110 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MCKINLEY PLACE (0014653) CEDAR GARDENS AID OPCO LLC Type: CBRF ADVANCED AGED (415) 995-5135 Class: CNA W56 N225 MCKINLEY BLVD IRREVERSIBLE DEMENTIA/ALZHEIM CEDARBURG WI 53012 ATTN: LEGAL DEPARTMENT Gender - Capacity: M/F - 65 (262) 376-7700 REEM YOKHANA 330 N WABASH STE 3700 Low/High rate: 2,706/5,671 PHYSICALLY DISABLED County: OZAUKEE CHICAGO IL 60611 Initial License: 07/11/2013 PUBLIC FUNDING MILAN ESTATES (0013355) SAUKVILLE INVESTMENTS LLC Type: CBRF HCBS COMPLIANT (262) 243-9610 Class: CNA 715 MILAN DR ADVANCED AGED SAUKVILLE WI 53080 STEVE WITKOWSKI Gender - Capacity: M/F - 22 (262) 284-1601 SANDRA RAASCH 715 MILAN DR Low/High rate: 4,650/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE SAUKVILLE WI 53080 Initial License: 08/10/2010 PHYSICALLY DISABLED TERMINALLY ILL NEW PERSPECTIVE-MEQUON (0011450) NEW PERSPECTIVES SENIOR LIVING Type: CBRF HCBS COMPLIANT (952) 746-3630 Class: CNA 3111 W MEQUON RD ADVANCED AGED MEQUON WI 53092 RYAN NOVACZYK Gender - Capacity: M/F - 16 (262) 242-1199 ANNA ANGLE 5900 CLEARWATER DR STE 500 Low/High rate: 3,870/4,410 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE MINNETONKA MN 55343 Initial License: 06/01/2006 NEW PERSPECTIVE-MEQUON (0011450) NEW PERSPECTIVES SENIOR LIVING Type: CBRF HCBS COMPLIANT (952) 746-3630 Class: CNA 3111 W MEQUON RD ADVANCED AGED MEQUON WI 53092 RYAN NOVACZYK Gender - Capacity: M/F - 16 (262) 242-1199 ANNA ANGLE 5900 CLEARWATER DR STE 500 Low/High rate: 3,870/4,410 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE MINNETONKA MN 55343 Initial License: 06/01/2006 NORPORT GROUP HOME (310490) INDIVIDUAL GROWTH SERVICES INC Type: CBRF HCBS COMPLIANT (262) 284-9656 Class: CNA 411 E NORPORT DR DEVELOPMENTALLY DISABLED PORT WASHINGTON WI 53074 SHAWN MILES Gender - Capacity: M/F - 8 (262) 284-6898 MELANIE CLAUSING 1000 N WISCONSIN STREET STE 5 Low/High rate: 3,911/3,911 County: OZAUKEE PORT WASHINGTON WI 53074 Initial License: 01/01/1982 OAK COURT GROUP HOME (310491) INDIVIDUAL GROWTH SERVICES INC Type: CBRF HCBS COMPLIANT (262) 284-9656 Class: AS 1265 OAK CT DEVELOPMENTALLY DISABLED PORT WASHINGTON WI 53074 SHAWN MILES Gender - Capacity: M/F - 8 (262) 284-3702 MELANIE CLAUSING 1000 N WISCONSIN ST STE 5 Low/High rate: 2,811/3,348 EMOTIONALLY DISTURBED/MENTAL County: OZAUKEE PORT WASHINGTON WI 53074-1286 Initial License: 08/01/1995 PUBLIC FUNDING PORT HAVEN (0012186) PORT HAVEN Type: CBRF HCBS COMPLIANT (262) 284-3908 Class: CNA 334 S GARFIELD AVE ADVANCED AGED PORT WASHINGTON WI 53074 CRAIG NICHELSON Gender - Capacity: M/F - 8 (262) 284-3908 CRAIG NICHELSON 334 S GARFIELD AVE Low/High rate: 3,700/5,000 DEVELOPMENTALLY DISABLED County: OZAUKEE PORT WASHINGTON WI 53074 Initial License: 01/16/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL ROSEWOOD MANOR (0016990) VALOR HOMES LLC Type: CBRF HCBS COMPLIANT (414) 915-0710 Class: CNA 1515 WASHINGTON ST ADVANCED AGED GRAFTON WI 53024 EMMY MYERS Gender - Capacity: M/F - 8 (262) 421-8337 EMMY MYERS 1515 WASHINGTON ST Low/High rate: DEVELOPMENTALLY DISABLED County: OZAUKEE GRAFTON WI 53024 Initial License: 01/31/2018 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL SILVER SPRINGS (0012125) SILVER SPRINGS OF MEQUON INC Type: CBRF HCBS COMPLIANT (262) 643-4223 Class: CNA 11840 N SILVER AVE ADVANCED AGED MEQUON WI 53097 JACQUELYNN C CHIARELLI Gender - Capacity: M/F - 8 (262) 643-4223 JACQUELYNN C CHIARELLI 11840 N SILVER AVE Low/High rate: 3,780/6,955 IRREVERSIBLE DEMENTIA/ALZHEIM County: OZAUKEE MEQUON WI 53097 Initial License: 03/04/2008 PUBLIC FUNDING VILLAGE POINTE COMMONS THE CRESTE (0016280) CAPRI LIFESTYLES LLC Type: CBRF HCBS COMPLIANT (262) 789-1224 Class: CNA 201 WALNUT DR ADVANCED AGED GRAFTON WI 53024 GLEN CHOBAN Gender - Capacity: M/F - 26 (262) 387-3149 KIMBERLY KAY 20875 Crossroads Cir Suite 400 Low/High rate: 5,025/7,175 DEVELOPMENTALLY DISABLED County: OZAUKEE WAUKESHA WI 53186 Initial License: 12/01/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 111 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs Association Approval: WALA VILLAGE POINTE COMMONS THE SPIRE (0016281) CAPRI LIFESTYLES LLC Type: CBRF HCBS COMPLIANT (262) 798-1224 Class: CNA 101 WALNUT CIRCLE ADVANCED AGED GRAFTON WI 53024 GLEN CHOBAN Gender - Capacity: M/F - 23 (262) 387-3147 KIMBERLY KAY 20875 Crossroads Cir Suite 400 Low/High rate: 3,450/5,750 DEVELOPMENTALLY DISABLED County: OZAUKEE WAUKESHA WI 53186 Initial License: 12/01/2016 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING TERMINALLY ILL Association Approval: WALA WOODLAND VIEW ESTATE (0011745) WOODLAND VIEW OF FREDONIA LLC Type: CBRF HCBS COMPLIANT (920) 254-6262 Class: CNA 348 S MILWAUKEE ST ADVANCED AGED FREDONIA WI 53021 HEATHER STAUTZ Gender - Capacity: M/F - 6 (262) 692-3760 DEBRA RICHARDS W3150 ELM LN Low/High rate: 2,700/3,777 DEVELOPMENTALLY DISABLED County: OZAUKEE SHEBOYGAN FALLS WI 53085 Initial License: 04/11/2007 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL COMFORTS OF HOME RIVER FALLS CBRF (0012426) RIVER FALLS CBRF LLC Type: CBRF HCBS COMPLIANT (651) 287-0265 Class: CNA 2328 AURORA CIRCLE ADVANCED AGED RIVER FALLS WI 54022 RHONDA SCHILLINGER Gender - Capacity: M/F - 32 (715) 425-1530 ASHLEY VERZIER 750 MAIN STREET STE 200 Low/High rate: 3,700/5,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: PIERCE MENDOTA HEIGHTS MN 55118 Initial License: 06/23/2008 PUBLIC FUNDING KINNIC FALLS ALCOHOL DRUG SERVS INC (0008581) KINNIC FALLS ALCOHOL DRUG SERVS INC Type: CBRF ADVANCED AGED (715) 426-5950 Class: AA 900 SOUTH ORANGE STREET ALCOHOL/DRUG DEPENDENT RIVER FALLS WI 54022 KATE IHUS Gender - Capacity: M - 52 (715) 426-5950 KATE IHUS 902 S ORANGE ST Low/High rate: 3,666/3,788 CORRECTIONAL CLIENTS County: PIERCE RIVER FALLS WI 54022-2819 Initial License: 09/02/1981 TRAUMATIC BRAIN INJURY OUR HOUSE RIVER FALLS MEMORY CARE (0013425) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 902 S WASSON LANE ADVANCED AGED RIVER FALLS WI 54022 LORI NARDIN Gender - Capacity: M/F - 20 (715) 426-0151 GRETCHEN MINKEL 4350 156TH STREET Low/High rate: 4,325/4,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: PIERCE CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING PARKSIDE (0009712) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: CNA 258 N BEULAH ST ADVANCED AGED ELLSWORTH WI 54011 NANCY STEWART Gender - Capacity: M/F - 8 (715) 273-5060 NANCY STEWART P O BOX 848 Low/High rate: 5,566/5,566 DEVELOPMENTALLY DISABLED County: PIERCE ELLSWORTH WI 54011 Initial License: 10/02/2002 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY PREFERRED SENIOR LIVING OF ELLSWORTH (0014905) PREFERRED SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (651) 383-4850 Class: CNA 429 W WAYNE ST ADVANCED AGED ELLSWORTH WI 54011 BETHANY FRIEDRICH Gender - Capacity: M/F - 43 (715) 273-6600 BETHANY FRIEDRICH 429 W WAYNE ST Low/High rate: 3,000/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: PIERCE ELLSWORTH WI 54011 Initial License: 10/17/2014 PUBLIC FUNDING RIDGEWOOD CBRF (510281) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AS N7211 HWY 65 DEVELOPMENTALLY DISABLED RIVER FALLS WI 54022 NANCY STEWART Gender - Capacity: M/F - 8 (715) 425-1183 NANCY STEWART P O BOX 848 Low/High rate: 4,349/5,103 EMOTIONALLY DISTURBED/MENTAL County: PIERCE ELLSWORTH WI 54011 Initial License: 02/15/1995 TRAUMATIC BRAIN INJURY RIVER FALLS CBRF II LLC (0015130) RIVER FALLS CBRF II LLC Type: CBRF HCBS COMPLIANT (651) 287-0265 Class: CNA 2354 AURORA CIRCLE ADVANCED AGED RIVER FALLS WI 54022 RHONDA SCHILLINGER Gender - Capacity: M/F - 44 (715) 425-7711 CASSANDRA GAVIN 750 MAIN ST STE 200 Low/High rate: 4,700/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: PIERCE MENDOTA HEIGHTS MN 55118 Initial License: 06/09/2014 PHYSICALLY DISABLED PUBLIC FUNDING SEASONS (THE) (0015047) PLUM CITY CARE CENTER Type: CBRF ADVANCED AGED (715) 647-2401 Class: CNA 301 CHERRY AVE W PUBLIC FUNDING PLUM CITY WI 54761 CARLA HUTTER Gender - Capacity: M/F - 15 (715) 647-2169 CARLA HUTTER 301 CHERRY AVE W Low/High rate: 2,704/4,232 County: PIERCE PLUM CITY WI 54761 Initial License: 06/01/2014

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 112 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs Association Approval: WiCAL SUMMIT VIEW (510279) BROTOLOC HEALTH CARE SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 832-5085 Class: AS 278 N BEULAH STREET DEVELOPMENTALLY DISABLED ELLSWORTH WI 54011 NANCY STEWART Gender - Capacity: M/F - 8 (715) 273-6696 NANCY STEWART P O BOX 848 Low/High rate: 4,501/4,501 EMOTIONALLY DISTURBED/MENTAL County: PIERCE ELLSWORTH WI 54011 Initial License: 03/05/1995 TRAUMATIC BRAIN INJURY AMERY MEMORY CARE (0014758) AMERY ASSISTED LIVING PARTNERS LLC Type: CBRF HCBS COMPLIANT (715) 523-0030 Class: CNA 215 BIRCH STREET WEST ADVANCED AGED AMERY WI 54001 ANA HINES Gender - Capacity: M/F - 77 (715) 268-4800 ANA HINES 4407 124TH STREET Low/High rate: 4,400/10,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK CHIPPEWA FALLS WI 54729 Initial License: 09/16/2013 PUBLIC FUNDING CHRISTIAN COMMUNITY HOME OF OSCEOLA (0013865) CHRISTIAN COMMUNITY HOME OF OSCEOLA IN Type: CBRF ADVANCED AGED (715) 381-4210 Class: CNA 2650 65TH AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM OSCEOLA WI 54020 HEIDI MCGEEHAN Gender - Capacity: M/F - 20 (715) 294-1100 HEIDI MCGEEHAN 2650 65TH AVENUE Low/High rate: 4,092/6,386 PUBLIC FUNDING County: POLK OSCEOLA WI 54020 Initial License: 11/01/2011 Association Approval: LeadingAge Wisconsin COMFORTS OF HOME ST CROIX FALLS I (0010062) ST CROIX FALLS COH LLC Type: CBRF HCBS COMPLIANT (651) 287-0265 Class: CNA 343 MCKENNEY STREET ADVANCED AGED ST CROIX FALLS WI 54024 RHONDA SCHILLINGER Gender - Capacity: M/F - 15 (715) 483-1707 JANET OLSON 750 MAIN STREET, SUITE 200 Low/High rate: 3,500/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK MENDOTA HEIGHTS MN 55118 Initial License: 06/01/2003 PHYSICALLY DISABLED PUBLIC FUNDING COMFORTS OF HOME ST CROIX II (0010569) ST CROIX FALLS COH LLC Type: CBRF HCBS COMPLIANT (651) 287-0265 Class: CNA 341 MCKENNEY ST ADVANCED AGED ST CROIX FALLS WI 54024 RHONDA SCHILLINGER Gender - Capacity: M/F - 16 (715) 483-1707 JANET OLSON 750 MAIN STREET SUITE 200 Low/High rate: 3,500/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK MENDOTA HEIGHTS MN 55118 Initial License: 05/01/2004 PHYSICALLY DISABLED PUBLIC FUNDING EAGLE RIDGE SENIOR LIVING (0017895) GOOD LIFE SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (651) 426-6676 Class: CNA 101 RIDGE RD ADVANCED AGED OSCEOLA WI 54020 JULIE MARTIN Gender - Capacity: M/F - 32 (715) 294-8000 JULIE MARTIN 101 RIDGE RD Low/High rate: 3,999/5,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK OSCEOLA WI 54020 Initial License: 05/12/2020 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY LAWSON MANOR (0013979) UNITED PIONEER HOME, INC Type: CBRF HCBS COMPLIANT (715) 472-8475 Class: CNA 625 S. SECOND ST ADVANCED AGED LUCK WI 54853 JAY ANDRESS Gender - Capacity: M/F - 16 (715) 472-2164 JAY ANDRESS 623 S. SECOND ST Low/High rate: 3,825/4,641 PUBLIC FUNDING County: POLK LUCK WI 54853 Initial License: 02/23/2012 Association Approval: LeadingAge Wisconsin RIVERBEND (0010999) AMERY ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 268-9949 Class: CNA 475 GOLFVIEW ADVANCED AGED AMERY WI 54001 WHITNEY STRICKLAND Gender - Capacity: M/F - 11 (715) 268-9949 WHITNEY STRICKLAND 475 GOLFVIEW Low/High rate: 4,652/6,209 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK AMERY WI 54001 Initial License: 09/01/2005 RIVERBEND (0010999) AMERY ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 268-9949 Class: CNA 475 GOLFVIEW ADVANCED AGED AMERY WI 54001 WHITNEY STRICKLAND Gender - Capacity: M/F - 11 (715) 268-9949 WHITNEY STRICKLAND 475 GOLFVIEW Low/High rate: 4,652/6,209 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK AMERY WI 54001 Initial License: 09/01/2005 Association Approval: WiCAL SOPHIES MANOR ASSISTED LIVING II INC (0012368) LISA HOADLEY Type: CBRF HCBS COMPLIANT (763) 444-4771 Class: CNA 300 MICHIGAN AVE ADVANCED AGED CENTURIA WI 54824 LISA HOADLEY Gender - Capacity: M/F - 20 (715) 640-3330 DANNIELLE MUNKBERG P O BOX 340 Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK CENTURIA WI 54824 Initial License: 05/23/2008 PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: WALA

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 113 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

TRADITIONS OF FREDERIC (0013890) TRADITIONS OF FREDERIC LLC Type: CBRF HCBS COMPLIANT (651) 353-1532 Class: CNA 107 EAST OAK STREET ADVANCED AGED FREDERIC WI 54837 STEPHANIE SIEBENTHAL Gender - Capacity: M/F - 15 (715) 327-4394 STEPHANIE SIEBENTHAL 107 EAST OAK STREET Low/High rate: 3,450/4,725 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK FREDERIC WI 54837 Initial License: 10/13/2011 TRADITIONS OF FREDERIC 2 (0016172) TRADITIONS OF FREDERIC LLC Type: CBRF HCBS COMPLIANT (651) 353-1532 Class: CNA 105 OAK ST EAST ADVANCED AGED FREDERIC WI 54837 STEPHANIE SIEBENTHAL Gender - Capacity: M/F - 19 (715) 327-4888 STEPHANIE SIEBENTHAL 107 OAK ST EAST Low/High rate: 3,450/4,725 IRREVERSIBLE DEMENTIA/ALZHEIM County: POLK FREDERIC WI 54837 Initial License: 11/01/2016 PUBLIC FUNDING ASCENSION ST MICHAELS/RES TREATMENT CENTER (61 ASCENSION ST MICHAELS BEHAVIOR HEALTH Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 344-4611 Class: AS 201 PRENTICE STREET NORTH CORRECTIONAL CLIENTS STEVENS POINT WI 54481 LAURIE ROBERTS Gender - Capacity: M/F - 15 (715) 345-0711 LAURIE ROBERTS 209 PRENTICE ST NORTH Low/High rate: 6,780/13,740 County: PORTAGE STEVENS POINT WI 54481 Initial License: 04/01/1986 AURORA RESIDENTIAL ALTERNATIVES INC 062 (0013089 AURORA RESIDENTIAL ALTERNATIVES Type: CBRF HCBS COMPLIANT (715) 235-1839 Class: CNA 651 N 2ND ST DEVELOPMENTALLY DISABLED STEVENS POINT WI 54481 HOLLY HAKES Gender - Capacity: M/F - 6 (715) 345-2640 LINDA DALLAND PO BOX 68 Low/High rate: 5,262/7,802 EMOTIONALLY DISTURBED/MENTAL County: PORTAGE MENOMONIE WI 54751 Initial License: 12/17/2009 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CARE PARTNERS STEVENS POINT 1 (0011953) CARE PROPERTIES LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 3349 BLDG A WHITING AVENUE ADVANCED AGED STEVENS POINT WI 54481 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 345-9904 PETTI MANNEL PO BOX 3006 Low/High rate: 2,702/3,952 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE OSHKOSH WI 54903 Initial License: 07/02/2007 PHYSICALLY DISABLED TERMINALLY ILL CARE PARTNERS STEVENS POINT 2 (0011954) CARE PROPERTIES LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 3349 BLDG B WHITING AVENUE ADVANCED AGED STEVENS POINT WI 54481 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 341-1556 PETTI MANNEL PO BOX 3006 Low/High rate: 3,800/4,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE OSHKOSH WI 54903 Initial License: 07/02/2007 PHYSICALLY DISABLED TERMINALLY ILL DIMENSIONS LIVING STEVENS POINT (0015134) S-H OPCO OAKRIDGE LLC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 5625 SANDPIPER DR ADVANCED AGED STEVENS POINT WI 54481 LEXIE BAUM Gender - Capacity: M/F - 16 (715) 343-7376 JACQUELINE WILLIAMS 12900 WHITEWATER DR STE 201 Low/High rate: 4,195/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE MINNEAPOLIS MN 55343 Initial License: 08/29/2014 PUBLIC FUNDING GENERATIONS LLC (0014540) GENERATIONS LLC Type: CBRF HCBS COMPLIANT (715) 340-7443 Class: CNA 3120 ROSALIE PKWY ADVANCED AGED PLOVER WI 54467 JODY KLUCK Gender - Capacity: M/F - 6 (715) 340-7443 JODY KLUCK 3120 ROSALIE PKWY Low/High rate: 4,200/4,200 DEVELOPMENTALLY DISABLED County: PORTAGE PLOVER WI 54467 Initial License: 04/01/2013 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY HOME WITH FRIENDS ASSISTED LIVING LLC (0014841) HOME WITH FRIENDS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 252-4244 Class: CNA 1592 OKRAY AVE ADVANCED AGED PLOVER WI 54467 LYNN KUKLINSKI Gender - Capacity: M/F - 6 (715) 252-4244 LYNN KUKLINSKI 3370 ROYAL OAK DR Low/High rate: 4,500/6,500 DEVELOPMENTALLY DISABLED County: PORTAGE PLOVER WI 54467 Initial License: 11/21/2013 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 114 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

MAPLE RIDGE OF PLOVER (0012042) TANGLEWOOD ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (715) 498-4949 Class: CNA 2831 MAPLE DRIVE ADVANCED AGED PLOVER WI 54467 JESSICA SCHMIDT Gender - Capacity: M/F - 20 (715) 341-0909 KELLY PLISKA 2831 MAPLE DRIVE Low/High rate: 1,900/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE PLOVER WI 54467 Initial License: 09/01/2007 PUBLIC FUNDING TERMINALLY ILL MAPLE RIDGE OF PLOVER MEMORY CARE (0012043) TANGLEWOOD ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (715) 498-4949 Class: CNA 2841 MAPLE DRIVE ADVANCED AGED PLOVER WI 54467 JESSICA SCHMIDT Gender - Capacity: M/F - 20 (715) 342-0800 KELLY PLISKA 2831 MAPLE DRIVE Low/High rate: 2,200/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE PLOVER WI 54467 Initial License: 09/01/2007 PUBLIC FUNDING TERMINALLY ILL NORTH CREST (0016408) COPPERLEAF MANAGEMENT GROUP, INC. Type: CBRF HCBS COMPLIANT (715) 254-4357 Class: CNA 2225 EAGLE SUMMIT ADVANCED AGED STEVENS POINT WI 54482 KRISTA MENDYKE Gender - Capacity: M/F - 27 (715) 343-1288 JARETT YACH 1077 WILSHIRE BOULEVARD Low/High rate: 3,850/5,850 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE STEVENS POINT WI 54481 Initial License: 10/12/2016 PUBLIC FUNDING TERMINALLY ILL NORTH HAVEN (0008672) COPPERLEAF MANAGEMENT GROUP INC Type: CBRF HCBS COMPLIANT (715) 498-1678 Class: CNA 2301 EAGLE SUMMIT ADVANCED AGED STEVENS POINT WI 54482 KRISTA MENDYKE Gender - Capacity: M/F - 22 (715) 343-8820 JARETT YACH 1077 WILSHIRE BLVD Low/High rate: 3,850/5,850 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE STEVENS POINT WI 54481 Initial License: 09/08/1999 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL NORTH RIDGE (0010600) COPPERLEAF MANAGEMENT GROUP INC Type: CBRF HCBS COMPLIANT (715) 254-4357 Class: CNA 2201 EAGLE SUMMIT ADVANCED AGED STEVENS POINT WI 54482 KRISTA MENDYKE Gender - Capacity: M/F - 24 (715) 343-8825 JARETT YACH 1077 WILSHIRE BLVD Low/High rate: 3,850/5,850 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE STEVENS POINT WI 54481 Initial License: 05/27/2004 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY POINT MANOR ASSISTED LIVING (0017960) NSH STEVENS POINT MANOR LLC Type: CBRF HCBS COMPLIANT (414) 962-5250 Class: CNA 1800 SHERMAN AVENUE ADVANCED AGED STEVENS POINT WI 54481 JEFFREY HOEHN Gender - Capacity: M/F - 29 (715) 344-0207 KATTIE FREDERICKSON 640 N VEL R PHILLIPS AVE STE 200 Low/High rate: 3,920/5,090 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE MILWAUKEE WI 53203 Initial License: 12/01/2019 PUBLIC FUNDING PORTAGE HOUSE (610004) PORTAGE COUNTY Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 346-1436 Class: AA 1019 ARLINGTON PLACE CORRECTIONAL CLIENTS STEVENS POINT WI 54481 ZACHARY BISHOP Gender - Capacity: M - 12 (715) 346-1436 ZACHARY BISHOP 1019 ARLINGTON PLACE Low/High rate: 27,111/27,111 County: PORTAGE STEVENS POINT WI 54481 Initial License: 04/01/1980 SYLVAN CROSSINGS OF STEVENS POINT (0011469) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 100 NORTH GREEN AVENUE ADVANCED AGED STEVENS POINT WI 54481 DANIEL FLEMING Gender - Capacity: M/F - 19 (715) 345-2304 WHITNEY PETERSON 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 3,450/7,050 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE MADISON WI 53711 Initial License: 05/01/2006 PUBLIC FUNDING SYLVAN CROSSINGS OF STEVENS POINT (0011469) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 100 NORTH GREEN AVENUE ADVANCED AGED STEVENS POINT WI 54481 DANIEL FLEMING Gender - Capacity: M/F - 19 (715) 345-2304 WHITNEY PETERSON 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 3,450/7,050 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE MADISON WI 53711 Initial License: 05/01/2006 PUBLIC FUNDING SYLVAN CROSSINGS OF STEVENS POINT (0011469) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 100 NORTH GREEN AVENUE ADVANCED AGED STEVENS POINT WI 54481 DANIEL FLEMING Gender - Capacity: M/F - 19 (715) 345-2304 WHITNEY PETERSON 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 3,450/7,050 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE MADISON WI 53711 Initial License: 05/01/2006 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 115 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SYLVAN CROSSINGS OF STEVENS POINT (0011469) TOUCHSTONE SENIOR SERVICES LLC Type: CBRF HCBS COMPLIANT (608) 276-3449 Class: CNA 100 NORTH GREEN AVENUE ADVANCED AGED STEVENS POINT WI 54481 DANIEL FLEMING Gender - Capacity: M/F - 19 (715) 345-2304 WHITNEY PETERSON 2960 TRIVERTON PIKE DR STE 202 Low/High rate: 3,450/7,050 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE MADISON WI 53711 Initial License: 05/01/2006 PUBLIC FUNDING WELLINGTON PLACE AT WHITING (0017437) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (303) 980-0611 Class: CNA 1902 POST ROAD ADVANCED AGED STEVENS POINT WI 54481 KRISTAN SCHAACK Gender - Capacity: M/F - 28 (715) 344-9669 KRISTAN SCHAACK 1902 POST ROAD Low/High rate: 2,570/5,850 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE STEVENS POINT WI 54481 Initial License: 02/26/2020 WHISPERING PINES CBRF (0012331) CRYSTAL FOUNTAINS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 348-9100 Class: CNA 3380 BRIDLEWOOD DR ADVANCED AGED PLOVER WI 54467 KAREN TRZEBIATOWSKI Gender - Capacity: M/F - 40 (715) 342-4445 KAREN TRZEBIATOWSKI 3450 BRIDLEWOOD DR Low/High rate: 3,985/5,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE PLOVER WI 54467 Initial License: 03/05/2008 PHYSICALLY DISABLED PUBLIC FUNDING WILLOW BROOKE POINT SENIOR LIVING CBRF (0015624) STEVENS POINT SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (715) 344-7902 Class: CNA 1800 BLUEBELL LN ADVANCED AGED STEVENS POINT WI 54481 LEE JOHNSON Gender - Capacity: M/F - 52 (715) 344-7902 KIMBERLEY SPURGEON 1675 E RIVERSIDE DR STE 150 Low/High rate: 2,045/6,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: PORTAGE EAGLE ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING ASPIRUS PLEASANT VIEW REGENCY HOUSE (0012357) ASPIRUS EXTENDED SERVICES INC Type: CBRF ADVANCED AGED (715) 847-2116 Class: CNA 615 PETERSON AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM PHILLIPS WI 54555 STACY POMEROY Gender - Capacity: M/F - 20 (715) 339-6284 THOMAS KASTER 595 PETERSON DRIVE Low/High rate: 4,208/4,802 PHYSICALLY DISABLED County: PRICE PHILLIPS WI 54555 Initial License: 04/01/2008 TERMINALLY ILL LAKESIDE VILLA LLC (0014844) LAKESIDE VILLA LLC Type: CBRF HCBS COMPLIANT (715) 339-3939 Class: CNA 804 LAKE AVENUE ADVANCED AGED PHILLIPS WI 54555 TIFFANY GEIGER Gender - Capacity: M/F - 20 (715) 339-3939 TIFFANY GEIGER PO BOX 207 Low/High rate: 3,800/ DEVELOPMENTALLY DISABLED County: PRICE HALES CORNERS WI 53130 Initial License: 12/02/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED WATERFORD AT PARK FALLS (THE) (0015956) CSL PARK FALLS LLC Type: CBRF ADVANCED AGED (972) 308-8387 Class: CNA 354 LINDEN STREET IRREVERSIBLE DEMENTIA/ALZHEIM PARK FALLS WI 54552-5455 KIRSTEN HUTCHISON Gender - Capacity: M/F - 36 (715) 744-2444 KIRSTEN HUTCHISON 1740 CONDOR LANE Low/High rate: 3,100/4,200 PHYSICALLY DISABLED County: PRICE GREEN BAY WI 54313 Initial License: 01/21/2016 TERMINALLY ILL WOODLANDS (0017397) PARK MANOR LTD DBA WOODLANDS Type: CBRF HCBS COMPLIANT (715) 762-2449 Class: CNA 250 LAWRENCE AVE ADVANCED AGED PARK FALLS WI 54552 SHARON SCHULTZ Gender - Capacity: M/F - 8 (715) 762-2449 KRISTA BOLEY 250 LAWRENCE AVE Low/High rate: 3,400/4,700 County: PRICE PARK FALLS WI 54552 Initial License: 07/18/2019 ARBOR VIEW COMMUNITIES (0017134) ARHC AVBURWI01 TRS LLC C/O HEALTHCARE T Type: CBRF ADVANCED AGED (212) 415-6500 Class: CNA 34201 ARBOR LN IRREVERSIBLE DEMENTIA/ALZHEIM BURLINGTON WI 53105 MICHELLE VIOL Gender - Capacity: M/F - 40 (262) 539-2728 MICHELLE VIOL 34201 ARBOR LN Low/High rate: 3,900/4,500 PHYSICALLY DISABLED County: RACINE BURLINGTON WI 53105 Initial License: 06/22/2018 TERMINALLY ILL TRAUMATIC BRAIN INJURY ARBOR VIEW MEMORY CARE (0017133) ARHC AVBURWI01 TRS LLC C/O HEALTHCARE T Type: CBRF ADVANCED AGED (212) 415-6500 Class: CNA 34111 ARBOR LN IRREVERSIBLE DEMENTIA/ALZHEIM BURLINGTON WI 53105 MICHELLE VIOL Gender - Capacity: M/F - 10 (262) 539-2738 MICHELLE VIOL 34111 ARBOR LN Low/High rate: 4,500/5,500 County: RACINE BURLINGTON WI 53105 Initial License: 06/22/2018 CALEBRIA HOUSE (0015143) HIGH POINT ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (262) 767-7300 Class: CNA 155 BETH COURT ADVANCED AGED BURLINGTON WI 53105 RICK WASMUND Gender - Capacity: M/F - 7 (262) 767-7300 RICK WASMUND 155 BETH COURT Low/High rate: 3,800/5,000 DEVELOPMENTALLY DISABLED County: RACINE BURLINGTON WI 53105 Initial License: 08/05/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 116 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CALEBRIA HOUSE (0015143) HIGH POINT ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (262) 767-7300 Class: CNA 155 BETH COURT ADVANCED AGED BURLINGTON WI 53105 RICK WASMUND Gender - Capacity: M/F - 7 (262) 767-7300 RICK WASMUND 155 BETH COURT Low/High rate: 3,800/5,000 DEVELOPMENTALLY DISABLED County: RACINE BURLINGTON WI 53105 Initial License: 08/05/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY EAGLE HOUSE (310369) COMMUNITY CONNECTION LLC Type: CBRF HCBS COMPLIANT (414) 906-1915 Class: AA 807 53RD DR ALCOHOL/DRUG DEPENDENT UNION GROVE WI 53182 ROBERT LIEBERMAN Gender - Capacity: M/F - 8 (262) 835-8370 ANGELA ANDERSEN 5225 N IRONWOOD LN STE 116 Low/High rate: 4,500/4,500 DEVELOPMENTALLY DISABLED County: RACINE GLENDALE WI 53217 Initial License: 10/10/1995 EMOTIONALLY DISTURBED/MENTAL TRAUMATIC BRAIN INJURY GENESIS CROSSROADS (310435) GENESIS BEHAVIORAL SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 377-3021 Class: AA 4107 4109 ST CLAIR ST CORRECTIONAL CLIENTS RACINE WI 53402 PATRICIA FAULHABER Gender - Capacity: F - 9 (414) 377-3021 PATRICIA FAULHABER 2819 W highland blvd Low/High rate: 2,499/2,499 EMOTIONALLY DISTURBED/MENTAL County: RACINE Milwaukee WI 53208 Initial License: 10/15/1990 PUBLIC FUNDING HIL FOX MEAD GROUP HOME (0009691) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 516 FOX MEAD CROSSING DEVELOPMENTALLY DISABLED WATERFORD WI 53185 LYNN MATZKE Gender - Capacity: M/F - 8 (262) 514-3500 KELLY THOMPSON 1249 RUSSETT COURT Low/High rate: 5,442/5,442 PHYSICALLY DISABLED County: RACINE GREEN BAY WI 54313 Initial License: 01/01/2002 PUBLIC FUNDING HIL HILLSIDE (0009760) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 373 CHURCH ST DEVELOPMENTALLY DISABLED BURLINGTON WI 53105 LYNN MATZKE Gender - Capacity: M/F - 8 (262) 569-5515 KELLY THOMPSON 1249 RUSSETT COURT Low/High rate: 5,675/5,675 PUBLIC FUNDING County: RACINE GREEN BAY WI 54313 Initial License: 01/01/2002 HIL KENDRICK HOME (0010610) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 265 N KENDRICK AVE DEVELOPMENTALLY DISABLED BURLINGTON WI 53105 LYNN MATZKE Gender - Capacity: M/F - 6 (262) 767-7411 KELLY THOMPSON 1249 RUSSETT COURT Low/High rate: 5,968/5,968 EMOTIONALLY DISTURBED/MENTAL County: RACINE GREEN BAY WI 54313 Initial License: 08/10/2005 PHYSICALLY DISABLED PUBLIC FUNDING HIL KENNEDY HOME (0012307) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 4305 4307 KENNEDY DR DEVELOPMENTALLY DISABLED RACINE WI 53404 LYNN MATZKE Gender - Capacity: M/F - 6 (262) 456-4279 KELLY THOMPSON 1249 RUSSETT COURT Low/High rate: 8,773/8,773 PHYSICALLY DISABLED County: RACINE GREEN BAY WI 54313 Initial License: 06/23/2008 PUBLIC FUNDING HIL WANDA FROGG VILLA/MEADOWHAVEN (0012315) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 524 SUMMIT AVE DEVELOPMENTALLY DISABLED BURLINGTON WI 53105 LYNN MATZKE Gender - Capacity: M/F - 6 (262) 767-0239 KELLY THOMPSON 1249 RUSSETT COURT Low/High rate: 4,589/4,589 EMOTIONALLY DISTURBED/MENTAL County: RACINE GREEN BAY WI 54313 Initial License: 06/03/2008 PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: WALA LAKEVIEW CARE PARTNERS AT WATERFORD (0016391) LAKEVIEW CARE PARTNERS INC Type: CBRF ALCOHOL/DRUG DEPENDENT (262) 534-7292 Class: CNA 1701 SHARP RD DEVELOPMENTALLY DISABLED WATERFORD WI 53185 ANDY OLIVARES Gender - Capacity: M/F - 20 (262) 534-7297 ANDY OLIVARES 1701 SHARP RD Low/High rate: 5,131/22,500 PHYSICALLY DISABLED County: RACINE WATERFORD WI 53185 Initial License: 09/01/2016 PUBLIC FUNDING TRAUMATIC BRAIN INJURY LAKEVIEW CARE PARTNERS AT WATERFORD II (0016982 LAKEVIEW CARE PARTNERS INC Type: CBRF ADVANCED AGED (262) 534-7297 Class: CA 1701 SHARP RD ALCOHOL/DRUG DEPENDENT WATERFORD WI 53185 ANDY OLIVARES Gender - Capacity: M/F - 8 (262) 534-7297 ANDY OLIVARES 1701 SHARP RD Low/High rate: 8,998/54,750 DEVELOPMENTALLY DISABLED County: RACINE WATERFORD WI 53185 Initial License: 09/19/2018 TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 117 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LAUREL HOUSE (310621) GENESIS BEHAVIORAL SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 892-4961 Class: AA 1725 1727 SPRING PL CORRECTIONAL CLIENTS RACINE WI 53404 PATRICIA FAULHABER Gender - Capacity: F - 12 (414) 892-4961 PATRICIA FAULHABER 6737 W WASHINGTON ST #2210 Low/High rate: 2,800/2,800 EMOTIONALLY DISTURBED/MENTAL County: RACINE WEST ALLIS WI 53214 Initial License: 10/01/1994 PUBLIC FUNDING LONG LAKE HOUSE (0011322) AFFINITY HEALTH CARE LLC Type: CBRF HCBS COMPLIANT (262) 895-3052 Class: AA 8208 RACINE AVE ALCOHOL/DRUG DEPENDENT WIND LAKE WI 53185 PAULA HEYER Gender - Capacity: M/F - 8 (262) 895-3052 THOMAS SCHILLING 8208 RACINE AVE Low/High rate: 4,500/6,000 DEVELOPMENTALLY DISABLED County: RACINE WIND LAKE WI 53185 Initial License: 08/30/2006 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY MAGNOLIA HILL - MT PLEASANT C CBRF (0017186) STONE HILL GRAFTON LLC Type: CBRF HCBS COMPLIANT (312) 622-3266 Class: CNA 3820 OLD GREEN BAY RD ADVANCED AGED MOUNT PLEASANT WI 53403 JIM ZACHE Gender - Capacity: M/F - 8 (262) 226-2893 TAMARA MCCONNELL 314 E MAIN STREET Low/High rate: 4,149/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE WATERTOWN WI 53094 Initial License: 06/27/2018 PHYSICALLY DISABLED TERMINALLY ILL MAGNOLIA HILL - MT PLEASANT A CBRF (0017189) STONEHILL GRAFTON LLC Type: CBRF HCBS COMPLIANT (312) 622-3266 Class: CNA 3820 OLD GREEN BAY RD ADVANCED AGED MOUNT PLEASANT WI 53403 JIM ZACHE Gender - Capacity: M/F - 8 (262) 226-2893 Tamara McConnell 314 E MAIN STREET Low/High rate: 4,500/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE WATERTOWN WI 53094 Initial License: 06/27/2018 PHYSICALLY DISABLED TERMINALLY ILL MAGNOLIA HILL - MT PLEASANT B CBRF (0017188) STONE HILL GRAFTON LLC Type: CBRF HCBS COMPLIANT (312) 622-3266 Class: CNA 3820 OLD GREEN BAY RD ADVANCED AGED MOUNT PLEASANT WI 53403 JIM ZACHE Gender - Capacity: M/F - 8 (262) 226-2893 TAMARA MCCONNELL 314 E MAIN STREET Low/High rate: 4,500/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE WATERTOWN WI 53094 Initial License: 06/27/2018 PHYSICALLY DISABLED TERMINALLY ILL MAPLEWOOD APPLEWOOD COTTAGE (0015968) ELDER CARE COTTAGES OF WISCONSIN LLC Type: CBRF ADVANCED AGED (262) 895-2332 Class: CNA 7711 BIG BEND RD IRREVERSIBLE DEMENTIA/ALZHEIM WATERFORD WI 53185 CATHY FENNEMA Gender - Capacity: M/F - 30 (262) 895-2332 CATHY FENNEMA 7711 BIG BEND RD Low/High rate: 4,000/6,050 PHYSICALLY DISABLED County: RACINE WATERFORD WI 53185 Initial License: 04/28/2016 PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY NEW VISION HOME LLC II (0014935) NEW VISION ADULT FAMILY HOME LLC Type: CBRF HCBS COMPLIANT (262) 554-9566 Class: CNA 1449 N GREEN BAY ROAD ADVANCED AGED MT PLEASANT WI 53406 SHALANDA BEDFORD Gender - Capacity: M/F - 8 (262) 633-9920 ERICA MARKS PO BOX 085782 Low/High rate: 3,000/6,000 ALCOHOL/DRUG DEPENDENT County: RACINE RACINE WI 53408 Initial License: 01/30/2014 CORRECTIONAL CLIENTS DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY OAK PARK PLACE OF BURLINGTON (0016395) OAK PARK PLACE OF BURLINGTON LLC Type: CBRF ADVANCED AGED (608) 729-2981 Class: CNA 1700 TEUT RD IRREVERSIBLE DEMENTIA/ALZHEIM BURLINGTON WI 53105 SCOTT FRANK Gender - Capacity: M/F - 95 (262) 758-6700 HEIDI SKOKUT 719 JUPITER DR Low/High rate: 3,500/6,000 PHYSICALLY DISABLED County: RACINE MADISON WI 53718 Initial License: 03/14/2017 TERMINALLY ILL PARKVIEW GARDENS III (0016971) KORU HEALTH LLC Type: CBRF ADVANCED AGED (414) 507-6928 Class: CNA 5321 DOUGLAS AVE IRREVERSIBLE DEMENTIA/ALZHEIM CALEDONIA WI 53402 ANDY LANGE Gender - Capacity: M/F - 40 (262) 898-4000 ANDY LANGE 6650 W STATE ST D112 Low/High rate: 4,500/7,000 PHYSICALLY DISABLED County: RACINE WAUWATOSA WI 53213 Initial License: 06/04/2018 PUBLIC FUNDING TERMINALLY ILL *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 118 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PINE BROOK POINTE (0008582) PINE BROOK POINTE KDK DEVELOPMENT Type: CBRF HCBS COMPLIANT (262) 767-1516 Class: CNA 1001 S PINE ST ADVANCED AGED BURLINGTON WI 53105 JOHN DIDIER Gender - Capacity: M/F - 66 (262) 767-1516 Barbera Sandy 1001 S PINE ST Low/High rate: 4,850/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE BURLINGTON WI 53105 Initial License: 07/06/1999 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY PROSPECT HEIGHTS COMMUNITY LIVING CENTER (0009 PROSPECT HEIGHTS LLC Type: CBRF HCBS COMPLIANT (262) 898-1029 Class: ANA 2015 PROSPECT ST ADVANCED AGED RACINE WI 53404 RANDAL MARVIN Gender - Capacity: M/F - 52 (262) 898-1029 RANDAL MARVIN 2015 PROSPECT ST Low/High rate: 2,126/2,281 ALCOHOL/DRUG DEPENDENT County: RACINE RACINE WI 53404 Initial License: 04/04/2003 CORRECTIONAL CLIENTS DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ROLLING MEADOWS (0012246) AFFINITY HEALTH CARE LLC Type: CBRF HCBS COMPLIANT (262) 895-6691 Class: CNA 8212 RACINE AVE ADVANCED AGED WIND LAKE WI 53185 THOMAS R SCHILLING Gender - Capacity: M/F - 8 (262) 895-3052 THOMAS SCHILLING 8208 RACINE AVE Low/High rate: 5,500/7,500 ALCOHOL/DRUG DEPENDENT County: RACINE WIND LAKE WI 53185 Initial License: 05/05/2008 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY ROSEWOOD OAKWOOD COTTAGE (0015967) ELDER CARE COTTAGES OF WISCONSIN LLC Type: CBRF HCBS COMPLIANT (262) 895-2332 Class: CNA 7711 BIG BEND RD ADVANCED AGED WATERFORD WI 53185 CATHY FENNEMA Gender - Capacity: M/F - 30 (262) 895-2332 CATHY FENNEMA 7711 BIG BEND RD Low/High rate: 4,000/6,050 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE WATERFORD WI 53185 Initial License: 04/28/2016 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY SAGE MEADOW RACINE (0017589) THOMAS OSTROM Type: CBRF HCBS COMPLIANT (312) 462-4462 Class: CNA 6109 BRAUN ROAD ADVANCED AGED RACINE WI 53403 THOMAS OSTROM Gender - Capacity: M/F - 26 (262) 554-6765 ROTH WEAVER 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE CHICAGO WI 60606 Initial License: 05/30/2019 TERMINALLY ILL ST MONICAS SENIOR LIVING INC (310557) ST MONICAS SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (262) 639-5050 Class: CNA 3920 N GREEN BAY RD ADVANCED AGED RACINE WI 53404 LORETTA BAXTER Gender - Capacity: M/F - 110 (262) 639-5050 STEPHANIE LICHTER 3920 N GREEN BAY RD Low/High rate: 2,802/4,847 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE RACINE WI 53404 Initial License: 10/16/1990 ST MONICAS SENIOR LIVING INC (310557) ST MONICAS SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (262) 639-5050 Class: CNA 3920 N GREEN BAY RD ADVANCED AGED RACINE WI 53404 LORETTA BAXTER Gender - Capacity: M/F - 110 (262) 639-5050 STEPHANIE LICHTER 3920 N GREEN BAY RD Low/High rate: 2,802/4,847 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE RACINE WI 53404 Initial License: 10/16/1990 Association Approval: LeadingAge Wisconsin ST MONICAS SENIOR LIVING INC MEMORY CARE (001681 ST MONICAS SENIOR LIVING INC Type: CBRF ADVANCED AGED (262) 639-5050 Class: CNA 3920 NORTH GREEN BAY ROAD IRREVERSIBLE DEMENTIA/ALZHEIM RACINE WI 53404 DANA PETIT Gender - Capacity: M/F - 26 (262) 639-5050 STEPHANY LICHTER 3920 NORTH GREEN BAY ROAD Low/High rate: 5,750/7,475 County: RACINE RACINE WI 53404 Initial License: 11/21/2017

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 119 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

TIMBER OAKS (310564) GALLINA HEALTH CARE NETWORK LTD Type: CBRF ADVANCED AGED (262) 878-4899 Class: CNA 1390 8TH AVE IRREVERSIBLE DEMENTIA/ALZHEIM UNION GROVE WI 53182 STEVEN KURANZ Gender - Capacity: M/F - 30 (262) 878-4899 SHERMAN KOEBERL 1400 8TH AVENUE Low/High rate: 2,846/3,468 PUBLIC FUNDING County: RACINE UNION GROVE WI 53182 Initial License: 09/04/1991 TIMBER OAKS (310564) GALLINA HEALTH CARE NETWORK LTD Type: CBRF ADVANCED AGED (262) 878-4899 Class: CNA 1390 8TH AVE IRREVERSIBLE DEMENTIA/ALZHEIM UNION GROVE WI 53182 STEVEN KURANZ Gender - Capacity: M/F - 30 (262) 878-4899 SHERMAN KOEBERL 1400 8TH AVENUE Low/High rate: 2,846/3,468 PUBLIC FUNDING County: RACINE UNION GROVE WI 53182 Initial License: 09/04/1991 Association Approval: WiCAL WATERFORD MEMORY CARE LLC (0014008) WATERFORD MEMORY CARE LLC Type: CBRF HCBS COMPLIANT (608) 751-1342 Class: CNA 301 S SIXTH ST ADVANCED AGED WATERFORD WI 53185 SCOTT SHADEL Gender - Capacity: M/F - 31 (262) 534-4800 TABBATHA CLAYBORN 2916 N HALL RD Low/High rate: 4,950/6,150 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE WHITEWATER WI 53190 Initial License: 06/29/2012 PUBLIC FUNDING Association Approval: WALA WOODS OF CALEDONIA (0018358) WOODS OF CALEDONIA MEMORY CARE LLC Type: CBRF HCBS COMPLIANT (773) 825-3336 Class: CNA 5737 ERIE STREET ADVANCED AGED CALEDONIA WI 53402 MORDY POLSTEIN Gender - Capacity: M/F - 64 (262) 822-3598 STEPHANIE EDEL 8170 MCCORMICK BLVD STE 112 Low/High rate: 4,100/6,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: RACINE SKOKIE IL 60076 Initial License: 01/16/2021 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WiCAL HARMONY PLACE ASSISTED LIVING LLC (0014443) HARMONY PLACE ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (608) 604-9366 Class: CNA 204 SOUTH STEWART ST ADVANCED AGED RICHLAND CENTER WI 53581 KAMI SCHNEIDER Gender - Capacity: M/F - 8 (608) 604-9366 KAMI J SCHNEIDER 800 N Orange St Low/High rate: 2,700/10,850 DEVELOPMENTALLY DISABLED County: RICHLAND RICHLAND CENTER WI 53581 Initial License: 03/10/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY HARVEST GUEST HOME (110455) JAYDEE ELDER CARE CORP Type: CBRF HCBS COMPLIANT (608) 647-8205 Class: ANA 875 WEST SIDE DR ADVANCED AGED RICHLAND CENTER WI 53581 JOSE D FLORES JR Gender - Capacity: M/F - 17 (608) 647-8205 Jose Flores JR 875 WEST SIDE DR Low/High rate: 3,950/4,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: RICHLAND RICHLAND CENTER WI 53581 Initial License: 01/17/1995 PUBLIC FUNDING Association Approval: WALA OUR HOUSE RICHLAND CENTER MEMORY CARE (001337 KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 240 N ORANGE ST ADVANCED AGED RICHLAND CENTER WI 53581 LORI NARDIN Gender - Capacity: M/F - 21 (608) 647-4533 Daylene Puckett 4350 156th ST Low/High rate: 4,200/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: RICHLAND CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING PINE VALLEY ASSISTED LIVING CENTER (0016213) RICHLAND COUNTY Type: CBRF HCBS COMPLIANT (608) 647-2138 Class: CNA 25951 CIRCLE VIEW LN ADVANCED AGED RICHLAND CENTER WI 53581 TOM RISLOW Gender - Capacity: M/F - 16 (608) 647-2138 TOM RISLOW 25951 CIRCLE VIEW LANE Low/High rate: 4,361/5,461 IRREVERSIBLE DEMENTIA/ALZHEIM County: RICHLAND RICHLAND CENTER WI 53581 Initial License: 11/03/2016 Association Approval: LeadingAge Wisconsin SAMARITAN HOUSE (110454) JAYDEE ELDER CARE CORP Type: CBRF HCBS COMPLIANT (608) 647-8205 Class: CNA 875 WEST SIDE DR ADVANCED AGED RICHLAND CENTER WI 53581 JOSE D FLORES JR Gender - Capacity: M/F - 8 (608) 647-8205 Jose Flores JR 875 WEST SIDE DR Low/High rate: 3,950/4,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: RICHLAND RICHLAND CENTER WI 53581 Initial License: 01/17/1995 PUBLIC FUNDING SCHMITT WOODLAND HILLS INC (110230) SCHMITT WOODLAND HILLS INC Type: CBRF ADVANCED AGED (608) 647-8931 Class: CNA 1400 W SEMINARY ST IRREVERSIBLE DEMENTIA/ALZHEIM RICHLAND CENTER WI 53581 JACKIE CARLEY Gender - Capacity: M/F - 30 (608) 647-8931 JACKIE CARLEY 1400 W SEMINARY ST Low/High rate: 5,083/6,191 PUBLIC FUNDING County: RICHLAND RICHLAND CENTER WI 53581 Initial License: 01/31/1988 *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 120 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs Association Approval: LeadingAge Wisconsin AZURA MEMORY CARE BELOIT 12 (0013403) AZURA BELOIT LLC Type: CBRF HCBS COMPLIANT (608) 365-7470 Class: CNA 2086 COLONY COURT ADVANCED AGED BELOIT WI 53511 JILL KREIDER Gender - Capacity: M/F - 12 (608) 365-7470 Sarah Searles 1233 MAYFAIR RD STE 301 Low/High rate: 5,075/6,375 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK MILWAUKEE WI 53226 Initial License: 08/15/2010 AZURA MEMORY CARE BELOIT 8 (0013407) AZURA BELOIT 2 LLC Type: CBRF HCBS COMPLIANT (608) 365-7470 Class: CNA 2096 COLONY COURT ADVANCED AGED BELOIT WI 53511 JILL KREIDER Gender - Capacity: M/F - 8 (608) 365-7470 Sarah Searles 1233 N MAYFAIR RD STE 301 Low/High rate: 5,075/6,375 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK MILWAUKEE WI 53226 Initial License: 08/15/2010 AZURA MEMORY CARE CLINTON (0013406) AZURA CLINTON LLC Type: CBRF HCBS COMPLIANT (608) 676-4056 Class: CNA 805 SUE LANE ADVANCED AGED CLINTON WI 53525 JILL KREIDER Gender - Capacity: M/F - 19 (608) 676-4056 Sarah Sealers 1233 N MAYFAIR RD STE 301 Low/High rate: 4,375/8,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK MILWAUKEE WI 53226 Initial License: 08/15/2010 AZURA MEMORY CARE CLINTON (0013406) AZURA CLINTON LLC Type: CBRF HCBS COMPLIANT (608) 676-4056 Class: CNA 805 SUE LANE ADVANCED AGED CLINTON WI 53525 JILL KREIDER Gender - Capacity: M/F - 19 (608) 676-4056 Sarah Sealers 1233 N MAYFAIR RD STE 301 Low/High rate: 4,375/8,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK MILWAUKEE WI 53226 Initial License: 08/15/2010 BEECHWOOD (0011374) DUNGARVIN WISCONSIN LLC Type: CBRF HCBS COMPLIANT (608) 752-8363 Class: CS 315 BEECHWOOD DRIVE DEVELOPMENTALLY DISABLED JANESVILLE WI 53548 VALERIE HARMAN Gender - Capacity: M/F - 7 (608) 754-8121 Julie Nalepinksi 111 N Main ST. STE 250 Low/High rate: 2,776/4,867 PUBLIC FUNDING County: ROCK JANESVILLE WI 53545 Initial License: 03/31/2006 CEDAR CREST ASSISTED LIVING (0008495) CEDAR CREST INC Type: CBRF ADVANCED AGED (608) 756-0344 Class: CNA 1704 S RIVER RD IRREVERSIBLE DEMENTIA/ALZHEIM JANESVILLE WI 53546 DAVID TANCK Gender - Capacity: M/F - 68 (608) 756-0344 DAVID TANCK 1702 S RIVER RD Low/High rate: 4,725/7,035 County: ROCK JANESVILLE WI 53546 Initial License: 10/31/1998 Association Approval: LeadingAge Wisconsin COZY LIL ACRE INC (0009460) COZY LIL ACRE INC Type: CBRF HCBS COMPLIANT (608) 758-1103 Class: CNA 521 NORTH GRANT Ave. ADVANCED AGED JANESVILLE WI 53548 MARY SANDERS Gender - Capacity: M/F - 12 (608) 758-1103 MARY SANDERS 521 NORTH GRANT ST Low/High rate: 2,800/3,165 PUBLIC FUNDING County: ROCK JANESVILLE WI 53548 Initial License: 11/05/2001 TERMINALLY ILL DUPONT (0011375) DUNGARVIN WISCONSIN LLC Type: CBRF HCBS COMPLIANT (608) 752-8363 Class: CNA 1945 DUPONT DR DEVELOPMENTALLY DISABLED JANESVILLE WI 53546 VALERIE HARMAN Gender - Capacity: M/F - 7 (608) 754-7573 Nalepinski Julie 111 N Main St. STE 250 Low/High rate: 4,257/7,285 PUBLIC FUNDING County: ROCK JANESVILLE WI 53545 Initial License: 12/01/2006 TRAUMATIC BRAIN INJURY EMERALD HOUSE (110283) PRODUCTIVE LIVING SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 831-3910 Class: AA 10304 WAL ROCK COUNTY LINE RD DEVELOPMENTALLY DISABLED WHITEWATER WI 53190 Productive Living Systems Gender - Capacity: M/F - 8 (262) 473-8407 Thomas Hastreiter 848 S. Janesville St Low/High rate: 6,065/6,065 EMOTIONALLY DISTURBED/MENTAL County: ROCK Whitewater WI 53190 Initial License: 05/30/1990 TRAUMATIC BRAIN INJURY HEARTHSIDE (110252) STONE RIDGE ESTATES INC Type: CBRF HCBS COMPLIANT (608) 754-2369 Class: CNA 2203 HANCOCK LANE ADVANCED AGED JANESVILLE WI 53545 WILLIAM WOLF Gender - Capacity: M/F - 8 (608) 757-2275 WILLIAM WOLF 1824 RIVERVIEW DRIVE Low/High rate: 2,900/2,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK JANESVILLE WI 53546 Initial License: 04/06/1989 PHYSICALLY DISABLED HEARTWARMING HOUSE LLC (THE) (0013013) THE HEARTWARMING HOUSE LLC Type: CBRF HCBS COMPLIANT (608) 302-8288 Class: CNA 238 EAST MADISON AVE ADVANCED AGED MILTON WI 53563 DOUGLAS HEARN Gender - Capacity: M/F - 16 (608) 868-3040 DOUGLAS HEARN 238 E MADISON AVE Low/High rate: 2,900/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK MILTON WI 53563 Initial License: 05/04/2010 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 121 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HUNTINGTON PLACE MEMORY CARE 1 (0014094) FVE MW LLC Type: CBRF HCBS COMPLIANT (608) 868-5055 Class: CNA 3828 E ROTAMER RD ADVANCED AGED JANESVILLE WI 53546 ROBYN JOHNSON Gender - Capacity: M/F - 11 (608) 868-5055 Robyn Johnson 3828 E ROTAMER RD Low/High rate: 4,324/4,824 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK JANESVILLE WI 53546 Initial License: 04/13/2012 PUBLIC FUNDING HUNTINGTON PLACE MEMORY CARE 2 (0014095) FVE MW LLC Type: CBRF HCBS COMPLIANT (608) 868-5057 Class: CNA 3840 E ROTAMER RD ADVANCED AGED JANESVILLE WI 53546 ROBYN JOHNSON Gender - Capacity: M/F - 8 (608) 868-5057 Robyn Johnson 400 Centre St. Low/High rate: 4,324/4,824 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK Newton MA 02458 Initial License: 04/13/2012 PUBLIC FUNDING HUNTINGTON PLACE MEMORY CARE 3 (0014097) FVE MW LLC Type: CBRF HCBS COMPLIANT (608) 868-2397 Class: CNA 3902 E ROTAMER RD ADVANCED AGED JANESVILLE WI 53546 ROBYN JOHNSON Gender - Capacity: M/F - 25 (608) 868-2397 Robyn Johnson 3902 E ROTAMER RD Low/High rate: 4,324/4,824 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK JANESVILLE WI 53546 Initial License: 04/13/2012 PUBLIC FUNDING KELLOGG (0011378) DUNGARVIN WISCONSIN LLC Type: CBRF HCBS COMPLIANT (608) 752-8363 Class: CS 1947 DUPONT DR DEVELOPMENTALLY DISABLED JANESVILLE WI 53546 VALERIE HARMAN Gender - Capacity: M/F - 8 (608) 756-5733 Julie Nalepinksi 111 N Main St. STE 250 Low/High rate: 1,846/4,143 PUBLIC FUNDING County: ROCK JANESVILLE WI 53545 Initial License: 03/31/2006 KELLY HOUSE (110260) SAEE INC. Type: CBRF HCBS COMPLIANT (608) 882-4191 Class: CNA 121 S 5TH ST ADVANCED AGED EVANSVILLE WI 53536 DIANE SKINNER Gender - Capacity: M/F - 8 (608) 882-4191 EMILY SHELTON 121 SOUTH 5TH ST Low/High rate: 2,675/4,600 DEVELOPMENTALLY DISABLED County: ROCK EVANSVILLE WI 53536 Initial License: 08/02/1989 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING LEE LANE (0011380) DUNGARVIN WISCONSIN LLC Type: CBRF HCBS COMPLIANT (608) 752-8363 Class: CNA 1620 LEE LANE DEVELOPMENTALLY DISABLED JANESVILLE WI 53546 VALERIE HARMAN Gender - Capacity: M/F - 6 (608) 741-1663 Julie Nalepinksi 111 N main St STE 250 Low/High rate: 3,660/6,060 PUBLIC FUNDING County: ROCK JANESVILLE WI 53545 Initial License: 03/31/2006 NEXT INNING (THE) (0016500) THE NEXT INNING LLC Type: CBRF ADVANCED AGED (608) 879-3084 Class: CNA 506 N MAIN ST EMOTIONALLY DISTURBED/MENTAL ORFORDVILLE WI 53576 STARR NUNN Gender - Capacity: M/F - 15 (608) 879-3084 STARR NUNN 307 GIFFORD ST Low/High rate: 3,400/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK ORFORDVILLE WI 53576 Initial License: 02/23/2017 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY OAK PARK PLACE OF JANESVILLE (0017017) OAK PARK PLACE OF JANESVILLE LLC Type: CBRF ADVANCED AGED (608) 279-0378 Class: CNA 700 MYRTLE WAY IRREVERSIBLE DEMENTIA/ALZHEIM JANESVILLE WI 53545 SCOTT FRANK Gender - Capacity: M/F - 65 (608) 530-5700 William Sekalias 719 JUPITER DRIVE Low/High rate: 1,777/2,560 County: ROCK MADISON WI 53718 Initial License: 06/15/2018 OUR HOUSE JANESVILLE ASSISTED CARE (0013378) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 2516 GREEN VALLEY DR ADVANCED AGED JANESVILLE WI 53546 LORI NARDIN Gender - Capacity: M/F - 20 (608) 756-1340 Misty Robinson 4350 156th ST Low/High rate: 4,185/4,935 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING OUR HOUSE JANESVILLE MEMORY CARE (0013381) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 4333 PHEASANT RUN RD ADVANCED AGED JANESVILLE WI 53546 LORI NARDIN Gender - Capacity: M/F - 16 (608) 756-9030 Daylene Puckett 4350 156th ST Low/High rate: 4,175/4,405 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 122 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

REM CANTERBURY (110449) REM WISCONSIN II INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA 3605/3607 CANTERBURY LA ADVANCED AGED JANESVILLE WI 53546 LORI WRIGHT Gender - Capacity: M/F - 6 (608) 322-4460 Christina Corey 4033 123rd ST, STE A Low/High rate: 6,090/6,090 DEVELOPMENTALLY DISABLED County: ROCK CHIPPEWA FALLS WI 54729 Initial License: 12/30/1994 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY REM JONATHON (110458) REM WISCONSIN II INC Type: CBRF HCBS COMPLIANT (608) 276-1191 Class: CNA 223 225 JONATHON DR ADVANCED AGED JANESVILLE WI 53548 LORI WRIGHT Gender - Capacity: M/F - 6 (608) 754-2412 Christina Corey 4033 123rd ST, STE A Low/High rate: 7,004/7,004 DEVELOPMENTALLY DISABLED County: ROCK CHIPPEWA FALLS WI 54729 Initial License: 02/01/1995 EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING TRAUMATIC BRAIN INJURY ROCK VALLEY COMM PROG INC CRISIS UNIT (0014440) ROCK VALLEY COMMUNITY PROGRAMS INC Type: CBRF EMOTIONALLY DISTURBED/MENTAL (608) 741-4500 Class: CNA 203 W SUNNY LANE RD PUBLIC FUNDING JANESVILLE WI 53546 ANGELA EGGERS Gender - Capacity: M/F - 15 (608) 741-4500 ANGELA EGGERS 203 W SUNNY LANE RD Low/High rate: 4,700/5,833 County: ROCK JANESVILLE WI 53546 Initial License: 02/01/2013 ROCK VALLEY COMMUNITY PROGRAMS INC (111054) ROCK VALLEY COMMUNITY PROGRAMS INC Type: CBRF ALCOHOL/DRUG DEPENDENT (608) 741-4500 Class: CNA 203 WEST SUNNY LANE RD CORRECTIONAL CLIENTS JANESVILLE WI 53546 ANGELA EGGERS Gender - Capacity: M/F - 100 (608) 741-4500 ANGELA EGGERS 203 WEST SUNNY LANE RD Low/High rate: 2,311/3,069 County: ROCK JANESVILLE WI 53546 Initial License: 12/31/1997 SHERMAN HOME (THE) (110107) CARTOGRAPHICS CORPORATION Type: CBRF HCBS COMPLIANT (608) 758-3324 Class: AS 1321 SHERMAN AVE ADVANCED AGED JANESVILLE WI 53545 PATRICIA A HUBBARD Gender - Capacity: M/F - 8 (608) 752-3711 kim hernandez 1519 W COURT ST Low/High rate: 2,495/3,100 DEVELOPMENTALLY DISABLED County: ROCK JANESVILLE WI 53548 Initial License: 02/28/1987 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM TRAUMATIC BRAIN INJURY ST ELIZABETH MANOR (0012686) ST ELIZABETH MANOR INC Type: CBRF HCBS COMPLIANT (608) 876-4000 Class: CNA 111 COMMERCIAL DR ADVANCED AGED FOOTVILLE WI 53537 Michelle Godfrey Gender - Capacity: M/F - 80 (608) 876-4000 Drew Flores PO BOX 217 Low/High rate: 4,250/5,300 DEVELOPMENTALLY DISABLED County: ROCK FOOTVILLE WI 53537 Initial License: 04/06/2009 IRREVERSIBLE DEMENTIA/ALZHEIM TRAUMATIC BRAIN INJURY Association Approval: LeadingAge Wisconsin SUITES AT BELOIT (THE) (0017474) AJ ALF OPERATIONS LLC Type: CBRF HCBS COMPLIANT (732) 358-6883 Class: CNA 2122 PIONEER DRIVE ADVANCED AGED BELOIT WI 53511 TAMMY BAILEY Gender - Capacity: M/F - 54 (608) 365-9451 TAMMY BAILEY 2122 PIONEER DRIVE Low/High rate: 4,000/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK BELOIT WI 53511 Initial License: 02/01/2019 PHYSICALLY DISABLED TERMINALLY ILL SV SOUTH BELOIT EAST (0017754) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 2775 KADLEC DR ADVANCED AGED BELOIT WI 53511 JEFFREY SEEGMILLER Gender - Capacity: M/F - 8 (608) 362-8092 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 3,000/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK WITTENBERG WI 54499 Initial License: 10/01/2019 PHYSICALLY DISABLED TERMINALLY ILL SV SOUTH BELOIT EAST II (0017753) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 2775 KADLEC DR ADVANCED AGED BELOIT WI 53511 JEFFREY SEEGMILLER Gender - Capacity: M/F - 15 (608) 362-8092 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 3,000/5,400 DEVELOPMENTALLY DISABLED County: ROCK WITTENBERG WI 54499 Initial License: 10/01/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 123 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SV SOUTH BELOIT NORTH (0017756) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 2027 COLONY COURT ADVANCED AGED BELOIT WI 53511 JEFFREY SEEGMILLER Gender - Capacity: M/F - 18 (608) 361-6990 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 3,000/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK WITTENBERG WI 54499 Initial License: 10/25/2019 PHYSICALLY DISABLED TERMINALLY ILL SV SOUTH BELOIT TERRACE (0017749) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 2771 IVA COURT ADVANCED AGED BELOIT WI 53511 JEFFREY SEEGMILLER Gender - Capacity: M/F - 20 (608) 365-3737 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 3,200/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK WITTENBERG WI 54499 Initial License: 10/01/2019 PHYSICALLY DISABLED TERMINALLY ILL SV SOUTH BELOIT WEST (0017752) SPL WISCONSIN LLC Type: CBRF HCBS COMPLIANT (715) 793-4466 Class: CNA 2156 HOUSE ST ADVANCED AGED BELOIT WI 53511 JEFFREY SEEGMILLER Gender - Capacity: M/F - 15 (608) 365-7455 JEFFREY SEEGMILLER PO BOX 262 Low/High rate: 3,200/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK WITTENBERG WI 54499 Initial License: 10/01/2019 PHYSICALLY DISABLED TERMINALLY ILL WILLOWICK (0017877) WILLOWICK ASSISTED LIVING BELOIT II LLC Type: CBRF HCBS COMPLIANT (608) 774-2104 Class: CNA 2240 CRANSTON RD ADVANCED AGED BELOIT WI 53511 LORI SCHLOSSER Gender - Capacity: M/F - 26 (608) 774-2104 Jessica Hutchinson 3275 Lamplighter Trail Low/High rate: 3,900/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK Beloit WI 53511 Initial License: 12/12/2019 PHYSICALLY DISABLED TERMINALLY ILL WILLOWICK BELOIT (0016999) WILLOWICK ASSISTED LIVING BELOIT LLC Type: CBRF ADVANCED AGED (262) 613-8819 Class: CNA 1971 CRANSTON RD IRREVERSIBLE DEMENTIA/ALZHEIM BELOIT WI 53511 TAMMY BRENNER Gender - Capacity: M/F - 24 (608) 305-1010 Jessica Hutchinson 3275 Lamplighter Trail Low/High rate: 3,650/4,450 PHYSICALLY DISABLED County: ROCK Beloit WI 53511 Initial License: 12/21/2017 TERMINALLY ILL WILLOWICK CLINTON (0015942) WILLOWICK SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (262) 613-8819 Class: CNA 306 OGDEN AVE ADVANCED AGED CLINTON WI 53525 LORI SCHLOSSER Gender - Capacity: M/F - 26 (608) 774-2104 DEANNA OLAYEMI 3725 Lamplighter Trail Low/High rate: 3,550/4,350 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK Beloit WI 53511 Initial License: 01/20/2016 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL WILLOWICK MOMENTS (0018180) WILLOWICK ASSISTED LIVING BELOIT III LLC Type: CBRF HCBS COMPLIANT (608) 774-2104 Class: CNA 3024 SOUTH BARTELLS DRIVE ADVANCED AGED BELOIT WI 53511 JEFFRY HOWARD Gender - Capacity: M/F - 24 (608) 774-2104 DEAHNA OLAYCMI 3275 Lamplighter Trail Low/High rate: 4,800/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK Beloit WI 53511 Initial License: 09/02/2020 PHYSICALLY DISABLED TERMINALLY ILL WILLOWICK MOMENTS CLINTON (0017456) WILLOWICK MEMORY CARE CLINTON LLC Type: CBRF ADVANCED AGED (608) 305-1010 Class: CNA 304 OGDEN AVE EMOTIONALLY DISTURBED/MENTAL CLINTON WI 53525 JEFFRY HOWARD Gender - Capacity: M/F - 21 (608) 676-6256 DEANNA OLAYEMI 2316 MINERAL POINT STE 10 Low/High rate: 4,400/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: ROCK JANESVILLE wi 53548 Initial License: 02/01/2019 PHYSICALLY DISABLED TERMINALLY ILL WRIGHT HOME (110210) CARTOGRAPHICS CORP Type: CBRF HCBS COMPLIANT (608) 758-3324 Class: AS 637 N WRIGHT RD ADVANCED AGED JANESVILLE WI 53546 PATRICIA HUBBARD Gender - Capacity: M/F - 8 (608) 756-5807 PATRICIA HUBBARD 1519 W COURT ST Low/High rate: 2,700/3,100 DEVELOPMENTALLY DISABLED County: ROCK JANESVILLE WI 53548 Initial License: 11/30/1990 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 124 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CARE PARTNERS ASSISTED LIVING - LADYSMITH (00126 CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 1105 BAKER AVE ADVANCED AGED LADYSMITH WI 54848 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 532-0818 NANETTE HARTMAN P O BOX 3006 Low/High rate: 3,200/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: RUSK OSHKOSH WI 54903 Initial License: 01/01/2009 PHYSICALLY DISABLED TERMINALLY ILL COUNTRY TERRACE LADYSMITH (0009673) COUNTRY TERRACE OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 910 SHADY LANE ADVANCED AGED LADYSMITH WI 54848 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 532-6993 NANNETTE HARTMAN PO BOX 3006 Low/High rate: 2,600/3,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: RUSK OSHKOSH WI 54903-3006 Initial License: 09/06/2002 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL LAKE MANOR (510330) LAKE MANOR LLC Type: CBRF HCBS COMPLIANT (715) 532-6090 Class: CNA 119 E 4TH ST N ADVANCED AGED LADYSMITH WI 54848 CHERYL KELLEY Gender - Capacity: M/F - 20 (715) 532-6090 MICHELLE NILES 119 E 4TH ST N Low/High rate: 4,243/8,060 IRREVERSIBLE DEMENTIA/ALZHEIM County: RUSK LADYSMITH WI 54848 Initial License: 07/01/1991 Association Approval: WiCAL ARTISAN BARABOO II (THE) (0014424) MOSAIC MANAGEMENT GROUP LLC Type: CBRF HCBS COMPLIANT (262) 754-4800 Class: CNA 1114 SILVER DRIVE ADVANCED AGED BARABOO WI 53913 KRISTA MCCOOK Gender - Capacity: M/F - 16 (608) 356-4837 Nicole Revels 15400 W CAPITOL DR SUITE 100 Low/High rate: 2,800/4,700 EMOTIONALLY DISTURBED/MENTAL County: SAUK BROOKFIELD WI 53005 Initial License: 12/01/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING CASA DE OAKES (0008972) CASA DE OAKES INC Type: CBRF HCBS COMPLIANT (608) 524-9876 Class: CNA E6846 FAWN VALLEY DR DEVELOPMENTALLY DISABLED REEDSBURG WI 53959 REBECCA J KNULL Gender - Capacity: M/F - 8 (608) 524-2283 REBECCA J KNULL 1130 BINDL DRIVE Low/High rate: 3,906/5,792 EMOTIONALLY DISTURBED/MENTAL County: SAUK REEDSBURG WI 53959 Initial License: 05/01/2000 PHYSICALLY DISABLED PUBLIC FUNDING CASA DE OAKES (0008972) CASA DE OAKES INC Type: CBRF HCBS COMPLIANT (608) 524-9876 Class: CNA E6846 FAWN VALLEY DR DEVELOPMENTALLY DISABLED REEDSBURG WI 53959 REBECCA J KNULL Gender - Capacity: M/F - 8 (608) 524-2283 REBECCA J KNULL 1130 BINDL DRIVE Low/High rate: 3,906/5,792 EMOTIONALLY DISTURBED/MENTAL County: SAUK REEDSBURG WI 53959 Initial License: 05/01/2000 PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: WALA CASA DE OAKES ASSISTED LIVING (0015819) CASA DE OAKES INC Type: CBRF HCBS COMPLIANT (608) 524-9876 Class: CNA 1130 BINDL DRIVE ADVANCED AGED REEDSBURG WI 53959 REBECCA KNULL Gender - Capacity: M/F - 20 (608) 524-9876 REBECCA J KNULL 1130 BINDL DRIVE Low/High rate: 2,359/4,320 PHYSICALLY DISABLED County: SAUK REEDSBURG WI 53959 Initial License: 11/01/2015 TRAUMATIC BRAIN INJURY Association Approval: WALA CASA DE OAKES INC REEDSBURG (0012392) CASA DE OAKES INC Type: CBRF HCBS COMPLIANT (608) 524-9876 Class: AA 201 SOUTH GROVE ST DEVELOPMENTALLY DISABLED REEDSBURG WI 53959 REBECCA KNULL Gender - Capacity: M/F - 8 (608) 524-6254 REBECCA J KNULL 1130 BINDL DRIVE Low/High rate: 3,227/4,642 PUBLIC FUNDING County: SAUK REEDSBURG WI 53959 Initial License: 07/01/2008 CASA DE OAKES INC REEDSBURG (0012392) CASA DE OAKES INC Type: CBRF HCBS COMPLIANT (608) 524-9876 Class: AA 201 SOUTH GROVE ST DEVELOPMENTALLY DISABLED REEDSBURG WI 53959 REBECCA KNULL Gender - Capacity: M/F - 8 (608) 524-6254 REBECCA J KNULL 1130 BINDL DRIVE Low/High rate: 3,227/4,642 PUBLIC FUNDING County: SAUK REEDSBURG WI 53959 Initial License: 07/01/2008 Association Approval: WALA CASA DE OAKES MEMORY CARE (0016006) CASA DE OAKES INC Type: CBRF HCBS COMPLIANT (608) 524-9876 Class: CNA 1130 BINDL DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM REEDSBURG WI 53959 REBECCA KNULL Gender - Capacity: M/F - 20 (608) 524-9876 REBECCA KNULL 1130 BINDL DRIVE Low/High rate: 4,188/7,045 PHYSICALLY DISABLED County: SAUK REEDSBURG WI 53959 Initial License: 03/15/2016 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 125 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs Association Approval: WALA COUNTRY CASA (0010325) CAROL L MOE KIEFER Type: CBRF HCBS COMPLIANT (608) 524-9729 Class: ANA E8509 N REEDSBURG RD DEVELOPMENTALLY DISABLED REEDSBURG WI 53959 CAROL L MOE KIEFER Gender - Capacity: M/F - 8 (608) 524-8054 CAROL L MOE KIEFER E6844 FAWN VALLEY RD Low/High rate: 2,583/2,835 EMOTIONALLY DISTURBED/MENTAL County: SAUK REEDSBURG WI 53959 Initial License: 11/06/2003 HARMONY HILLS (0016795) HARMONY PLACE ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (608) 983-2901 Class: CNA E4796 NARROWS CREEK RD DEVELOPMENTALLY DISABLED LOGANVILLE WI 53943 KAMI SCHNEIDER Gender - Capacity: M/F - 8 (608) 727-2259 KAMI SCHNEIDER 880 N ORANGE ST Low/High rate: 2,700/14,000 EMOTIONALLY DISTURBED/MENTAL County: SAUK RICHLAND CENTER WI 53581 Initial License: 12/06/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY MEADOW LANE (110191) SSM HEALTH CARE OF WISCONSIN INC Type: CBRF ADVANCED AGED (608) 258-6120 Class: CNA 1414 JEFFERSON ST PUBLIC FUNDING BARABOO WI 53913 RONNIE SCHAETZL Gender - Capacity: M/F - 25 (608) 355-3325 Alexis Marlette 1414 JEFFERSON ST Low/High rate: 3,286/4,402 County: SAUK BARABOO WI 53913 Initial License: 01/01/1986 Association Approval: LeadingAge Wisconsin MEADOW RIDGE ASSISTED LIVING LLC (0009753) ELDERSPAN MANAGEMENT LLC Type: CBRF HCBS COMPLIANT (608) 243-8800 Class: CNA 1700 JEFFERSON ST ADVANCED AGED BARABOO WI 53913 DAVID R GRIFFIN Gender - Capacity: M/F - 24 (608) 356-8770 HEATHER GODEMANN 2445 DARWIN ROAD STE 109 Low/High rate: 5,070/5,370 IRREVERSIBLE DEMENTIA/ALZHEIM County: SAUK MADISON WI 53704 Initial License: 09/17/2002 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL WAIVER CERTIFIED INDEPENDENT C Association Approval: LeadingAge Wisconsin MEADOW VIEW (0011486) ELDERSPAN MANAGEMENT LLC Type: CBRF HCBS COMPLIANT (608) 243-8800 Class: CNA 1600 JEFFERSON ST ADVANCED AGED BARABOO WI 53913 DAVID GRIFFIN Gender - Capacity: M/F - 17 (608) 356-2944 HEATHER GODEMANN 2445 DARWIN ROAD STE 109 Low/High rate: 5,760/6,060 IRREVERSIBLE DEMENTIA/ALZHEIM County: SAUK MADISON WI 53704 Initial License: 06/29/2006 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin MEADOWS OF SPRING GREEN (THE) (110558) ELDERSPAN MANAGEMENT LLC Type: CBRF HCBS COMPLIANT (608) 243-8800 Class: CNA 477 RAINBOW RD ADVANCED AGED SPRING GREEN WI 53588 DAVID GRIFFIN Gender - Capacity: M/F - 24 (608) 588-2101 RAEANN MARTEN 2445 DARWIN ROAD STE 109 Low/High rate: 4,980/6,090 IRREVERSIBLE DEMENTIA/ALZHEIM County: SAUK MADISON WI 53704 Initial License: 12/09/1996 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin OAK PARK PLACE BARABOO AUTUMN LANE (0012510) OAK PARK PLACE OF BARABOO LLC Type: CBRF HCBS COMPLIANT (608) 663-8606 Class: CNA 800 WALDO ST ADVANCED AGED BARABOO WI 53913 SCOTT FRANK Gender - Capacity: M/F - 34 (608) 663-8600 Brittany Snell 719 JUPITER DR Low/High rate: 5,678/6,222 IRREVERSIBLE DEMENTIA/ALZHEIM County: SAUK MADISON WI 53718 Initial License: 11/19/2008 PUBLIC FUNDING OUR HOUSE BARABOO ASSISTED CARE (0013376) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 1200 WASHINGTON AVE ADVANCED AGED BARABOO WI 53913 LORI NARDIN Gender - Capacity: M/F - 20 (608) 355-2344 Joni Spawn 4350 156th ST Low/High rate: 4,200/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: SAUK CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING OUR HOUSE REEDSBURG ASSISTED CARE (0013666) KEYSTONE REEDSBURG LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 355 MACK DR ADVANCED AGED REEDSBURG WI 53959 LORI NARDIN Gender - Capacity: M/F - 16 (608) 524-6116 LESLEY PAPARA 4350 156th St. Low/High rate: 3,400/3,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: SAUK CHIPPEWA FALLS WI 54729 Initial License: 04/15/2011 PUBLIC FUNDING *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 126 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

OUR HOUSE REEDSBURG MEMORY CARE (0013375) KSMS OUR HOUSE LLC Type: CBRF ADVANCED AGED (317) 280-8455 Class: CNA 1135 17TH COURT IRREVERSIBLE DEMENTIA/ALZHEIM REEDSBURG WI 53959 LORI NARDIN Gender - Capacity: M/F - 12 (608) 524-1321 Kimberly Krueger 4350 156th ST Low/High rate: 3,675/3,675 PUBLIC FUNDING County: SAUK CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PINE VILLA MEMORY CARE (0016643) ELDERSPAN MANAGEMENT LLC Type: CBRF ADVANCED AGED (608) 243-8800 Class: CNA 890 PRAIRIE STREET IRREVERSIBLE DEMENTIA/ALZHEIM PRAIRIE DU SAC WI 53578 DARLA ARMSTRONG Gender - Capacity: M/F - 19 (608) 643-7343 DEB PETE 2445 DARWIN ROAD SUITE 109 Low/High rate: 6,000/6,450 PHYSICALLY DISABLED County: SAUK MADISON WI 53704 Initial License: 06/07/2017 TERMINALLY ILL Association Approval: LeadingAge Wisconsin ASPEN ACRES ASSISTED LIVING LLC (0015864) ASPEN ACRES ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 634-5700 Class: CNA 10214 ROCK CREEK ROAD ADVANCED AGED HAYWARD WI 54843 BRIAN SPIELMANN Gender - Capacity: M/F - 28 (715) 558-4545 MEGAN YLITALO PO BOX 1390 Low/High rate: 3,200/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: SAWYER HAYWARD WI 54843 Initial License: 11/16/2015 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA CARE PARTNERS ASSISTED LVG HAYWARD (0009028) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 15497 PINEWOOD DRIVE ADVANCED AGED HAYWARD WI 54843 JASON LINDEMANN Gender - Capacity: M/F - 13 (715) 634-5767 NANNETTE HARTMAN P O BOX 3006 Low/High rate: 2,022/3,645 DEVELOPMENTALLY DISABLED County: SAWYER OSHKOSH WI 54903 Initial License: 05/21/2000 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL COUNTRY TERRACE HAYWARD (0012899) COUNTRY TERRACE OF WISCONSIN LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 10260 WHITE BIRCH LANE ADVANCED AGED HAYWARD WI 54843 JASON LINDEMANN Gender - Capacity: M/F - 16 (715) 634-1447 NAN HARTMAN P O BOX 3006 Low/High rate: 3,400/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: SAWYER OSHKOSH WI 54903 Initial License: 08/01/2009 PHYSICALLY DISABLED TERMINALLY ILL HARBOR LIVING LLC (0018281) HARBOR LIVING LLC Type: CBRF ADVANCED AGED (715) 492-1242 Class: CNA 10179 RANGER STATION ROAD DEVELOPMENTALLY DISABLED HAYWARD WI 54843 NICOLE CLARK Gender - Capacity: M/F - 16 (715) 934-3094 NICOLE CLARK N4093 KEEHN ROAD Low/High rate: 3,000/4,500 EMOTIONALLY DISTURBED/MENTAL County: SAWYER WINTER WI 54896 Initial License: 12/09/2020 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY QUEEN OF ANGELS CONVENT AND CBRF (610287) ORDER OF ST FRANCIS OF ASSISI INC Type: CBRF HCBS COMPLIANT (715) 945-2203 Class: CNA 11428 WEST STATE ROAD 27/70 ADVANCED AGED RADISSON WI 54867-7006 MARY HILDEBRAND Gender - Capacity: M/F - 12 (715) 945-2203 MARY HILDEBRAND 11428 WEST STATE ROAD 27/70 Low/High rate: 3,000/3,300 DEVELOPMENTALLY DISABLED County: SAWYER RADISSON WI 54867-7006 Initial License: 12/01/1994 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY TRANSITIONS (0012868) SAWYER COUNTY HEALTH AND HUMAN SERVIC Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 634-4806 Class: AA 16208 WOODRIDGE LANE EMOTIONALLY DISTURBED/MENTAL HAYWARD WI 54843 PAUL GRAHOVAC Gender - Capacity: M/F - 8 (715) 638-3241 JOE BODO 10610 MAIN STREET STE 224 Low/High rate: 2,568/4,409 County: SAWYER HAYWARD WI 54843 Initial License: 04/26/2010 AUTUMN LANE FAMILY CARE (0017994) CADY MEMORIAL HOME INC Type: CBRF HCBS COMPLIANT (715) 449-3177 Class: CNA 384 LYONS ROAD ADVANCED AGED BIRNAMWOOD WI 54414 TRACY ANDERSON Gender - Capacity: M/F - 16 (715) 449-3444 TRACY ANDERSON PO BOX 220 Low/High rate: 2,500/4,000 DEVELOPMENTALLY DISABLED County: SHAWANO BIRNAMWOOD WI 54414 Initial License: 03/06/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 127 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CADY MEMORIAL HOME (0017997) CADY MEMORIAL HOME INC Type: CBRF HCBS COMPLIANT (715) 449-3177 Class: CNA 380 MAPLE STREET ADVANCED AGED BIRNAMWOOD WI 54414 TRACY ANDERSON Gender - Capacity: M/F - 17 (715) 449-3177 TRACY ANDERSON PO BOX 220 Low/High rate: 2,000/4,000 DEVELOPMENTALLY DISABLED County: SHAWANO BIRNAMWOOD WI 54414 Initial License: 03/06/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CLOVERLEAF TERRACE LLC (0015404) CLOVERLEAF TERRACE LLC Type: CBRF ADVANCED AGED (917) 226-8008 Class: CNA 401 CENTER ST DEVELOPMENTALLY DISABLED BIRNAMWOOD WI 54414 ALFRED D SCHULZ JR Gender - Capacity: - 15 (715) 449-9626 JAMIE WIERZBA 4735 MONTVIEW BLVD Low/High rate: 2,200/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHAWANO DENVER CO 80207 Initial License: 12/23/2014 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY COTTAGES MEMORY CARE THE (0014369) THE COTTAGES INVESTMENT GROUP LLC Type: CBRF HCBS COMPLIANT (715) 526-5166 Class: CNA 113 MADISON WAY IRREVERSIBLE DEMENTIA/ALZHEIM SHAWANO WI 54166 CARA PETERSON Gender - Capacity: M/F - 24 (715) 526-5166 CARA PETERSON 445 Cardinal Ln Suite102 Low/High rate: 4,955/5,965 PUBLIC FUNDING County: SHAWANO GREEN BAY WI 54313 Initial License: 10/25/2012 COTTAGES MEMORY CARE THE (0014369) THE COTTAGES INVESTMENT GROUP LLC Type: CBRF HCBS COMPLIANT (715) 526-5166 Class: CNA 113 MADISON WAY IRREVERSIBLE DEMENTIA/ALZHEIM SHAWANO WI 54166 CARA PETERSON Gender - Capacity: M/F - 24 (715) 526-5166 CARA PETERSON 445 Cardinal Ln Suite102 Low/High rate: 4,955/5,965 PUBLIC FUNDING County: SHAWANO GREEN BAY WI 54313 Initial License: 10/25/2012 Association Approval: WALA ELLA BESAW CENTER (410245) STOCKBRIDGE MUNSEE COMMUNITY Type: CBRF ADVANCED AGED (715) 793-4111 Class: CS N8697 MOH HE CON NUCK RD PHYSICALLY DISABLED BOWLER WI 54416 ERIN LEWIS Gender - Capacity: M/F - 8 (715) 793-4384 ERIN LEWIS N8697 MOH HE CON NUCK RD Low/High rate: 294/2,400 County: SHAWANO BOWLER WI 54416 Initial License: 02/15/1991 ELLA BESAW CENTER (410245) STOCKBRIDGE MUNSEE COMMUNITY Type: CBRF ADVANCED AGED (715) 793-4111 Class: CS N8697 MOH HE CON NUCK RD PHYSICALLY DISABLED BOWLER WI 54416 ERIN LEWIS Gender - Capacity: M/F - 8 (715) 793-4384 ERIN LEWIS N8697 MOH HE CON NUCK RD Low/High rate: 294/2,400 County: SHAWANO BOWLER WI 54416 Initial License: 02/15/1991 KINDREDHEARTS SHAWANO (0009722) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 422-8005 Class: CNA 1377 LINCOLN STREET ADVANCED AGED SHAWANO WI 54166 DOUGLAS HENNING Gender - Capacity: M/F - 16 (715) 524-6711 DOUGLAS HENNING 1377 LINCOLN STREET Low/High rate: 3,112/4,063 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHAWANO SHAWANO WI 54166 Initial License: 10/02/2002 PUBLIC FUNDING MAEHNOWESEKIYAH WELLNESS CENTER (410032) MENOMINEE INDIAN TRIBE OF WISCONSIN Type: CBRF ALCOHOL/DRUG DEPENDENT N2150 KESAEHKAHTEK (715) 799-3835 Class: AS GRESHAM WI 54128 DARLA ANN DICK Gender - Capacity: M/F - 16 (715) 799-5056 DARLA ANN DICK N2150 KESAEHKAHTEK Low/High rate: 4,800/4,800 County: SHAWANO GRESHAM WI 54128 Initial License: 07/01/1986 MEADOW VIEW ESTATES LLC (0014722) MEADOW VIEW ESTATES LLC Type: CBRF HCBS COMPLIANT (715) 758-1992 Class: CNA 400 W MILL ST ADVANCED AGED BONDUEL WI 54107 MELISSA TRINKO Gender - Capacity: M/F - 15 (715) 758-1992 MELISSA TRINKO 400 W MILL ST Low/High rate: 3,300/3,800 PHYSICALLY DISABLED County: SHAWANO BONDUEL WI 54107 Initial License: 08/15/2013 PAISERS OAKHAVEN S&C LLC BLDG I (0015454) PAISERS OAKHAVEN S&C LLC Type: CBRF HCBS COMPLIANT (715) 526-3324 Class: CNA 132 OAK CT ADVANCED AGED SHAWANO WI 54166 SCOTT PAISERS Gender - Capacity: M/F - 15 (715) 526-3324 SCOTT PAISER 142 OAK CT Low/High rate: 3,400/3,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHAWANO SHAWANO WI 54166 Initial License: 02/10/2015 PHYSICALLY DISABLED PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 128 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PAISERS OAKHAVEN S&C LLC BLDG II (0015453) PAISERS OAKHAVEN S&C LLC Type: CBRF HCBS COMPLIANT (715) 526-3324 Class: CNA 142 OAK CT ADVANCED AGED SHAWANO WI 54166 SCOTT PAISERS Gender - Capacity: M/F - 14 (715) 526-3324 SCOTT PAISER 142 OAK CT Low/High rate: 3,400/3,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHAWANO SHAWANO WI 54166 Initial License: 02/10/2015 PHYSICALLY DISABLED PUBLIC FUNDING ROSE MARY MANOR NORTH (0015395) PGU LLC Type: CBRF HCBS COMPLIANT (715) 489-3100 Class: CNA 309 MARBLE AVE ADVANCED AGED MATTOON WI 54450 NICOLE VANLANEN Gender - Capacity: M/F - 8 (715) 489-3100 CYNTHIA VANLANEN P O BOX 196 Low/High rate: 2,100/5,000 ALCOHOL/DRUG DEPENDENT County: SHAWANO MATTOON WI 54450 Initial License: 03/07/2016 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ROSE MARY MANOR SOUTH (0014864) PGU LLC Type: CBRF HCBS COMPLIANT (715) 216-0563 Class: CNA 309 MARBLE AVE ADVANCED AGED MATTOON WI 54450 NICOLE VANLANEN Gender - Capacity: M/F - 8 (715) 489-3100 NICOLE VANLANEN P O BOX 196 Low/High rate: 2,100/5,000 ALCOHOL/DRUG DEPENDENT County: SHAWANO MATTOON WI 54450 Initial License: 03/07/2016 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY SHAWANO PLACE (0017080) SHAWANO SENIOR LIVING Type: CBRF HCBS COMPLIANT (312) 462-4462 Class: CNA 1088 ENGLE DR ADVANCED AGED SHAWANO WI 54166 THOMAS OSTROM Gender - Capacity: M/F - 46 AARON HOFFMAN 101 N WACKER DR STE 616 Low/High rate: 3,000/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHAWANO CHICAGO IL 60642 Initial License: 05/16/2018 PHYSICALLY DISABLED TERMINALLY ILL WOLF RIVER CBRF (0011326) MENOMINEE INDIAN TRIBE OF WISCONSIN Type: CBRF HCBS COMPLIANT (715) 799-5154 Class: CNA N2222 WHITE CEDAR ROAD ADVANCED AGED GRESHAM WI 54128 TRACY CUMMINGS Gender - Capacity: M/F - 15 (715) 994-1452 TRACY CUMMINGS N2222 WHITE CEDAR ROAD Low/High rate: 1,500/6,293 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHAWANO GRESHAM WI 54128 Initial License: 02/10/2006 PUBLIC FUNDING ABODE (THE) (0017723) SHEBOYGAN COUNTY HALFWAY HOUSE Type: CBRF HCBS COMPLIANT (920) 458-5205 Class: AA 1117 CLARA AVE ALCOHOL/DRUG DEPENDENT SHEBOYGAN WI 53081 ERIK BUCHELT Gender - Capacity: M/F - 8 (920) 458-5205 ERIK BUCHELT 503 ONTARIO AVE Low/High rate: 0/2,800 CORRECTIONAL CLIENTS County: SHEBOYGAN SHEBOYGAN WI 53081 Initial License: 11/06/2019 EMOTIONALLY DISTURBED/MENTAL AZURA MEMORY CARE OF SHEBOYGAN 19 (0013433) AZURA SHEBOYGAN LLC Type: CBRF HCBS COMPLIANT (720) 838-2901 Class: CNA 2629 INDIANA AVE ADVANCED AGED SHEBOYGAN WI 53081 JILL KREIDER Gender - Capacity: M/F - 19 (920) 452-7171 ANNE BARTS 1233 N MAYFAIR RD STE 301 Low/High rate: 5,100/7,975 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN MILWAUKEE WI 53226 Initial License: 08/15/2010 AZURA MEMORY CARE SHEBOYGAN 2 (0013434) AZURA SHEBOYGAN 2 LLC Type: CBRF HCBS COMPLIANT (720) 838-2901 Class: CNA 2611 INDIANA AVE ADVANCED AGED SHEBOYGAN WI 53081 JILL KREIDER Gender - Capacity: M/F - 9 (920) 452-7171 ANNE BARTS 1233 N MAYFAIR RD STE 301 Low/High rate: 5,325/7,325 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN MILWAUKEE WI 53226 Initial License: 08/15/2010 BANCROFT HAUS OF HARVEST HOME SR LIVING SERV ( HARVEST HOME SENIOR LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (920) 901-9482 Class: CNA 2005 APPLETREE RD ADVANCED AGED HOWARDS GROVE WI 53083 BETH PAHMEIER Gender - Capacity: M/F - 8 (920) 550-3018 BETH PAHMEIER 2003 APPLETREE RD Low/High rate: 5,050/6,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN HOWARDS GROVE WI 53083 Initial License: 07/31/2012 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 129 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BEECHWOOD REST HOME (0017246) GENUINE HEARTS LLC Type: CBRF HCBS COMPLIANT (920) 461-8138 Class: CNA N1495 W HWY A ADVANCED AGED KEWASKUM WI 53040 ABEL SALDANA Gender - Capacity: M/F - 20 (262) 808-3550 JOANN THURMON 1566 W MASON ST Low/High rate: 90/335 DEVELOPMENTALLY DISABLED County: SHEBOYGAN GREEN BAY WI 54303 Initial License: 06/12/2018 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BRAEBURN HAUS OF HARVEST HOME SR LIVING SERVIC HARVEST HOME SENIOR LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (920) 901-9482 Class: CNA 2003 APPLETREE RD ADVANCED AGED HOWARDS GROVE WI 53083 BETH PAHMEIER Gender - Capacity: M/F - 8 (920) 550-3020 BETH PAHMEIER 2003 APPLETREE RD Low/High rate: 5,050/6,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN HOWARDS GROVE WI 53083 Initial License: 07/31/2012 PUBLIC FUNDING CALM HARBOR SHEBOYGAN (0017804) ELEVATE INC Type: CBRF EMOTIONALLY DISTURBED/MENTAL 1202 N 31ST ST (262) 677-2155 Class: AA SHEBOYGAN WI 53081 MARY SIMON Gender - Capacity: M/F - 10 (920) 458-6188 SETH HAMMES N169 W21005 MEADOW LN Low/High rate: 5,324/5,324 County: SHEBOYGAN JACKSON WI 53037 Initial License: 10/30/2019 CAMEO HOUSE OF HARVEST HOME SENIOR LVG SERVIC HARVEST HOME SENIOR LIVING SERVICES INC Type: CBRF ADVANCED AGED (920) 550-2018 Class: CNA 2002 APPLETREE RD IRREVERSIBLE DEMENTIA/ALZHEIM HOWARDS GROVE WI 53083 BETH PAHMEIER Gender - Capacity: M/F - 8 (920) 550-3035 BETH PAHMEIER 2003 APPLETREE RD Low/High rate: 5,800/7,500 PHYSICALLY DISABLED County: SHEBOYGAN HOWARDS GROVE WI 53083 Initial License: 01/26/2017 PUBLIC FUNDING CEDAR GROVE GARDENS I (0012460) SANDVIEW LLC Type: CBRF HCBS COMPLIANT (262) 873-0034 Class: CNA 606 VAN ALTENA AVE ADVANCED AGED CEDAR GROVE WI 53013 MARY READ Gender - Capacity: M/F - 22 (920) 668-6400 MARY M READ 1698 AQUA VIEW CT Low/High rate: 4,550/5,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN CEDARBURG WI 53012-9146 Initial License: 08/01/2008 PHYSICALLY DISABLED TERMINALLY ILL CEDAR GROVE GARDENS II (0012461) SANDVIEW LLC Type: CBRF HCBS COMPLIANT (262) 873-0034 Class: CNA 626 VAN ALTENA AVE ADVANCED AGED CEDAR GROVE WI 53013 MARY READ Gender - Capacity: M/F - 22 (920) 668-8600 MARY M READ 1698 AQUA VIEW CT Low/High rate: 4,550/5,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN CEDARBURG WI 53012-9146 Initial License: 08/01/2008 PHYSICALLY DISABLED TERMINALLY ILL CORTLAND HOUSE OF HARVEST HOME SENIOR LVG SE HARVEST HOME SENIOR LIVING SERVICES INC Type: CBRF ADVANCED AGED (920) 550-2018 Class: CNA 2004 APPLETREE RD IRREVERSIBLE DEMENTIA/ALZHEIM HOWARDS GROVE WI 53083 BETH PAHMEIER Gender - Capacity: M/F - 8 (920) 550-3039 BETH PAHMEIER 2003 APPLETREE RD Low/High rate: 5,800/7,500 PHYSICALLY DISABLED County: SHEBOYGAN HOWARDS GROVE WI 53083 Initial License: 01/26/2017 PUBLIC FUNDING COUNTRY SIDE MANOR EAST (0018352) ENCORE WISCONSIN LLC Type: CBRF ADVANCED AGED (312) 462-4462 Class: CNA 4221 KADLEC DRIVE IRREVERSIBLE DEMENTIA/ALZHEIM SHEBOYGAN WI 53083 THOMAS OSTROM Gender - Capacity: M/F - 16 (920) 452-2229 SUE QUIRT 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/7,000 PHYSICALLY DISABLED County: SHEBOYGAN CHICAGO IL 60606 Initial License: 05/01/2021 TERMINALLY ILL COUNTRY SIDE MANOR WEST (0018351) ENCORE WISCONSIN LLC Type: CBRF HCBS COMPLIANT (312) 462-4462 Class: CNA 4228 KADLEC DRIVE ADVANCED AGED SHEBOYGAN WI 53083 THOMAS OSTROM Gender - Capacity: M/F - 63 (920) 452-2229 SUE QUIRT 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN CHICAGO IL 60606 Initial License: 02/15/2021 PHYSICALLY DISABLED TERMINALLY ILL GABLES ON THE POND LLC I (0016833) GABLES ON THE POND LLC Type: CBRF ADVANCED AGED (262) 689-9725 Class: CNA 305 S SPRING STREET DEVELOPMENTALLY DISABLED RANDOM LAKE WI 53075 TINA THULL Gender - Capacity: M/F - 22 (920) 994-8304 THOMAS THULL 305 S SPRING STREET Low/High rate: 4,585/8,711 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN RANDOM LAKE WI 53075 Initial License: 10/18/2017 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 130 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

GABLES ON THE POND LLC II (0016834) GABLES ON THE POND LLC Type: CBRF ADVANCED AGED (262) 689-9725 Class: CNA 305A S SPRING STREET DEVELOPMENTALLY DISABLED RANDOM LAKE WI 53075 TINA THULL Gender - Capacity: M/F - 28 (920) 994-8304 THOMAS THULL 305A SPRING STREET Low/High rate: 4,585/8,711 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN RANDOM LAKE WI 53075 Initial License: 10/18/2017 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL GOLDEN HARBOR LLC (0013780) GOLDEN HARBOR LLC Type: CBRF HCBS COMPLIANT (414) 940-6608 Class: CNA 505 S WATER ST ADVANCED AGED SHEBOYGAN WI 53081 JOHN TERESINSKI Gender - Capacity: M/F - 40 (920) 451-6923 JACKIE HEIN 2448 S 102ND STREET SUITE #305 Low/High rate: 2,600/4,900 DEVELOPMENTALLY DISABLED County: SHEBOYGAN WEST ALLIS WI 53227 Initial License: 08/31/2011 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED HAVEN DRIVE ASSISTED LIVING (0015582) PINE HAVEN CHRISTIAN HOME INC Type: CBRF HCBS COMPLIANT (920) 467-2401 Class: CNA 220 HAVEN DR ADVANCED AGED SHEBOYGAN FALLS WI 53085 TAMMY REINHOLZ Gender - Capacity: - 45 (920) 467-2401 STANLEY KAYMEN 531 GIDDINGS AVENUE Low/High rate: 3,870/8,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN SHEBOYGAN FALLS WI 53085 Initial License: 08/03/2015 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: LeadingAge Wisconsin HIL KAUFMANN HOME (0009736) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 2307 N 30TH ST DEVELOPMENTALLY DISABLED SHEBOYGAN WI 53083 ASHLEY WILLIAMS Gender - Capacity: M/F - 8 (920) 457-6053 MICHELE MARTIN 1249 RUSSETT COURT Low/High rate: 3,931/3,931 EMOTIONALLY DISTURBED/MENTAL County: SHEBOYGAN GREEN BAY WI 54313 Initial License: 01/01/2002 PUBLIC FUNDING TRAUMATIC BRAIN INJURY HIL NEW HORIZONS (0010603) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA 1411 N 26TH ST DEVELOPMENTALLY DISABLED SHEBOYGAN WI 53081 ASHLEY WILLIAMS Gender - Capacity: M/F - 6 (920) 459-9554 MICHELE MARTIN 1249 RUSSETT COURT Low/High rate: 6,008/6,008 PUBLIC FUNDING County: SHEBOYGAN GREEN BAY WI 54313 Initial License: 06/14/2004 HIL PRAIRIE VIEW (0009737) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CS 4545 PRAIRIE VIEW RD DEVELOPMENTALLY DISABLED SHEBOYGAN WI 53081 ASHLEY WILLIAMS Gender - Capacity: M/F - 5 (920) 457-5154 MICHELE MARTIN 1249 RUSSETT COURT Low/High rate: 5,782/5,782 EMOTIONALLY DISTURBED/MENTAL County: SHEBOYGAN GREEN BAY WI 54313 Initial License: 01/01/2002 PUBLIC FUNDING TRAUMATIC BRAIN INJURY KINDREDHEARTS PLYMOUTH (0009719) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 112 S RIVER BLVD ADVANCED AGED PLYMOUTH WI 53073 AMBER GRUNEWALD Gender - Capacity: M/F - 15 (920) 893-8334 AMBER GRUNEWALD 112 S RIVER BLVD Low/High rate: 3,948/5,441 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN PLYMOUTH WI 53073 Initial License: 10/02/2002 PUBLIC FUNDING PATHWAYS TO A BETTER LIFE DETOX (0016384) PATHWAYS TO A BETTER LIFE LLC Type: CBRF ALCOHOL/DRUG DEPENDENT 1102 W 1ST ST (920) 286-0189 Class: AA WALDO WI 53093 SUSAN BEATTIE Gender - Capacity: M/F - 12 (920) 894-1374 SUSAN BEATTIE PO BOX 347 Low/High rate: 1,500/45,000 County: SHEBOYGAN KIEL WI 53042 Initial License: 03/27/2017 PINE HAVEN CHRISTIAN COMMUNITIES - OOSTBURG (00 PINE HAVEN CHRISTIAN HOME INC Type: CBRF HCBS COMPLIANT (920) 467-2401 Class: CNA 701 PINE DR ADVANCED AGED OOSTBURG WI 53070 STEVE HENDRIKSE Gender - Capacity: M/F - 36 (920) 564-6800 STEVE HENDRIKSE 531 GIDDINGS AVE Low/High rate: 3,852/4,673 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN SHEBOYGAN FALLS WI 53070 Initial License: 12/31/2009 TERMINALLY ILL Association Approval: LeadingAge Wisconsin PINE HAVEN CHRISTIAN HOME (410472) PINE HAVEN CHRISTIAN HOME INC Type: CBRF HCBS COMPLIANT (920) 467-2401 Class: CNA 531 GIDDINGS AVE ADVANCED AGED SHEBOYGAN FALLS WI 53085 STEVE HENDRIKSE Gender - Capacity: M/F - 140 (920) 467-2401 STEVE HENDRIKSE 531 GIDDINGS AVE Low/High rate: 3,004/8,030 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN SHEBOYGAN FALLS WI 53085 Initial License: 08/01/1986 PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 131 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs Association Approval: LeadingAge Wisconsin SHEBOYGAN CO HALFWAY HOUSE (410480) SHEBOYGAN COUNTY HALFWAY HOUSE INC Type: CBRF HCBS COMPLIANT (920) 458-5205 Class: AA 503 ONTARIO AVE ADVANCED AGED SHEBOYGAN WI 53081 ERIK BUCHELT Gender - Capacity: M/F - 8 (920) 458-5205 ERIK BUCHELT 503 ONTARIO AVE Low/High rate: 2,732/3,188 ALCOHOL/DRUG DEPENDENT County: SHEBOYGAN SHEBOYGAN WI 53081 Initial License: 06/01/1979 CORRECTIONAL CLIENTS DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PUBLIC FUNDING SHEBOYGAN SENIOR COMMUNITY INC (0015786) SHEBOYGAN SENIOR COMMUNITY INC Type: CBRF ADVANCED AGED (920) 458-2137 Class: CNA 3505 CTY RD Y PUBLIC FUNDING SHEBOYGAN WI 53083 PAUL TREFFERT Gender - Capacity: M/F - 31 (920) 458-2137 PAUL TREFFERT 3505 CTY RD Y Low/High rate: 5,750/5,750 County: SHEBOYGAN SHEBOYGAN WI 53083 Initial License: 09/30/2015 Association Approval: LeadingAge Wisconsin SHORES OF SHEBOYGAN ASSISTED LIVING I (0015629) SHEBOYGAN SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 457-4000 Class: CNA 3315 SUPERIOR AVE ADVANCED AGED SHEBOYGAN WI 53081 LEE JOHNSON Gender - Capacity: M/F - 52 (920) 457-4000 TAMMY WAGNER 1675 E RIVERSIDE DR STE 150 Low/High rate: 3,030/6,606 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN EAGLE ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL SHORES OF SHEBOYGAN ASSISTED LIVING II THE (00156 SHEBOYGAN SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 457-4036 Class: CNA 3319 SUPERIOR AVE ADVANCED AGED SHEBOYGAN WI 53081 LEE JOHNSON Gender - Capacity: M/F - 32 (920) 457-4036 TAMMY WAGNER 1675 E RIVERSIDE DR STE 150 Low/High rate: 3,030/4,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN EAGLE ID 83616 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL SONGBIRD POND ASSISTED LIVING (0017490) CAVCO-PLYMOUTH LLC Type: CBRF HCBS COMPLIANT (262) 364-7229 Class: CNA 1900 ARBOR VIEW DR ADVANCED AGED PLYMOUTH WI 53073 SHARON DANE Gender - Capacity: M/F - 44 (920) 400-1375 SHARON DANE 1657 SHERWOOD DR Low/High rate: 3,700/5,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN CEDARBURG WI 53012 Initial License: 02/28/2019 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA VISTA CARE HELLER AVENUE (0018167) VISTA CARE WISCONSIN LLC Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 694-1102 Class: CNA 1528 NORTH 17TH STREET EMOTIONALLY DISTURBED/MENTAL SHEBOYGAN WI 53081 ROBERT BACHICHA Gender - Capacity: M/F - 8 (920) 395-4403 ROBERT BACHICHA 708 ERIE AVENUE SUITE 201 Low/High rate: 7,150/8,500 County: SHEBOYGAN SHEBOYGAN WI 53081 Initial License: 12/07/2020 VISTA CARE NORTH 33RD PLACE (0009340) VISTA CARE WISCONSIN INC Type: CBRF HCBS COMPLIANT (303) 489-1198 Class: CNA 1536 N 33RD PLACE DEVELOPMENTALLY DISABLED SHEBOYGAN WI 53081 ROBERT BACHICHA Gender - Capacity: M/F - 8 (920) 694-1132 ROBERT BACHICHA 708 ERIE AVE STE 2 Low/High rate: 6,000/6,000 EMOTIONALLY DISTURBED/MENTAL County: SHEBOYGAN SHEBOYGAN WI 53081 Initial License: 06/01/2001 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY WATERFORD AT PLYMOUTH I (THE) (0015201) CSL PLYMOUTH LLC Type: CBRF HCBS COMPLIANT (972) 308-8387 Class: CNA 2581 VALLEY RD ADVANCED AGED PLYMOUTH WI 53073 KIRSTEN HUTCHISON Gender - Capacity: M/F - 22 (920) 893-2754 KIRSTEN HUTCHISON 1740 CONDOR LANE Low/High rate: 4,200/7,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN GREEN BAY WI 54313 Initial License: 08/19/2014 WATERFORD AT PLYMOUTH II (THE) (0015202) CSL PLYMOUTH LLC Type: CBRF HCBS COMPLIANT (972) 308-8387 Class: CNA 2653 VALLEY RD ADVANCED AGED PLYMOUTH WI 53073 KIRSTEN HUTCHISON Gender - Capacity: M/F - 26 (920) 893-2754 KIRSTEN HUTCHISON 1740 CONDOR LANE Low/High rate: 3,500/7,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN GREEN BAY WI 54313 Initial License: 08/19/2014

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 132 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

WATERFORD AT PLYMOUTH III (THE) (0015204) CSL PLYMOUTH LLC Type: CBRF HCBS COMPLIANT (972) 308-8387 Class: CNA 2586 VALLEY RD ADVANCED AGED PLYMOUTH WI 53073 KIRSTEN HUTCHISON Gender - Capacity: - 34 (920) 892-8324 KIRSTEN HUTCHISON 1740 CONDOR LANE Low/High rate: 4,350/8,200 DEVELOPMENTALLY DISABLED County: SHEBOYGAN GREEN BAY WI 54313 Initial License: 08/19/2014 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL WOODLAND MANOR (0009403) COMMUNITY RETIREMENT LIVING INC Type: CBRF HCBS COMPLIANT (312) 794-8400 Class: CNA 851 FOND DU LAC AVE ADVANCED AGED SHEBOYGAN FALLS WI 53085 DOUGLAS CAMERON Gender - Capacity: M/F - 16 (920) 467-6270 MICHELE CRUZ 40950 WOODWARD AVE STE 3 Low/High rate: 2,995/4,330 IRREVERSIBLE DEMENTIA/ALZHEIM County: SHEBOYGAN BLOOMFIELD HILLS MI 48304 Initial License: 08/26/2001 TRAUMATIC BRAIN INJURY AURORA RES ALT NEW RICHMOND 005 (510214) AURORA RESIDENTIAL ALTERNATIVES INC Type: CBRF HCBS COMPLIANT (715) 235-1839 Class: AA 1710 COUNTY ROAD A EMOTIONALLY DISTURBED/MENTAL NEW RICHMOND WI 54017 DEENA BLACK Gender - Capacity: M/F - 8 (715) 246-4011 JILL MATTSON P O BOX 68 Low/High rate: 5,475/5,475 PUBLIC FUNDING County: ST CROIX MENOMONIE WI 54751 Initial License: 03/01/1980 AURORA RES ALTERNATIVES INC 075 (0008753) AURORA RESIDENTIAL ALTERNATIVES INC Type: CBRF HCBS COMPLIANT (715) 235-1839 Class: CNA 1740 6TH AVENUE DEVELOPMENTALLY DISABLED BALDWIN WI 54002 DEENA BLACK Gender - Capacity: M/F - 6 (715) 684-3162 SARAH SCHEERINGA P O BOX 68 Low/High rate: 4,429/7,337 PHYSICALLY DISABLED County: ST CROIX MENOMONIE WI 54751 Initial License: 10/01/1999 PUBLIC FUNDING TRAUMATIC BRAIN INJURY AURORA RES ALTERNATIVES INC 033 (0009230) AURORA RESIDENTIAL ALTERNATIVES INC Type: CBRF HCBS COMPLIANT (715) 235-1839 Class: CNA 230 CO ROAD SS DEVELOPMENTALLY DISABLED RIVER FALLS WI 54022 DEENA BLACK Gender - Capacity: M - 8 (715) 425-9215 SARA SCHEERINGA P O BOX 68 Low/High rate: 4,083/8,293 PUBLIC FUNDING County: ST CROIX MENOMONIE WI 54751 Initial License: 02/27/2001 TRAUMATIC BRAIN INJURY AURORA RESIDENTIAL ALTERNATIVES 023 (0011656) AURORA RESIDENTIAL ALTERNATIVES INC Type: CBRF HCBS COMPLIANT (715) 235-1839 Class: CNA 1760 SIXTH AVE DEVELOPMENTALLY DISABLED BALDWIN WI 54002 Deena Black Gender - Capacity: M/F - 6 (715) 684-2728 SARAH SCHEERINGA P O BOX 68 Low/High rate: 5,303/6,495 EMOTIONALLY DISTURBED/MENTAL County: ST CROIX MENOMONIE WI 54751 Initial License: 10/11/2006 PUBLIC FUNDING BIRCH HAVEN (0014945) BALDWIN CARE CENTER INC Type: CBRF HCBS COMPLIANT (715) 684-3231 Class: CNA 640 ELM ST ADVANCED AGED BALDWIN WI 54002 EILEEN LAFAVOR Gender - Capacity: M/F - 38 (715) 684-3231 EILEEN LAFAVOR 650 BIRCH STREET Low/High rate: 4,495/5,115 PUBLIC FUNDING County: ST CROIX BALDWIN WI 54002 Initial License: 01/23/2014 Association Approval: LeadingAge Wisconsin BURKWOOD TREATMENT CENTER (0012365) CRC WISCONSIN RD LLC D/B/A BURKWOOD Type: CBRF ALCOHOL/DRUG DEPENDENT 615 OLD MILL RD (715) 386-6125 Class: AA HUDSON WI 54016 CHUCK MYERS Gender - Capacity: M/F - 28 (715) 386-6125 CHUCK MYERS 615 OLD MILL RD Low/High rate: 6,900/7,650 County: ST CROIX HUDSON WI 54016 Initial License: 09/16/2008 COMFORTS OF HOME BALDWIN (0009851) BALDWIN COH LLC Type: CBRF HCBS COMPLIANT (651) 287-0265 Class: CNA 1880 FOURTH AVE ADVANCED AGED BALDWIN WI 54002 RHONDA SCHILLINGER Gender - Capacity: M/F - 15 (715) 688-2750 ASHLEY VERZIER 750 MAIN ST STE 200 Low/High rate: 3,400/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: ST CROIX MENDOTA HEIGHTS MN 55118 Initial License: 12/01/2002 PHYSICALLY DISABLED PUBLIC FUNDING COMFORTS OF HOME HUDSON (0010987) HUDSON COH LLC Type: CBRF HCBS COMPLIANT (651) 287-0265 Class: CNA 1111 HEGGEN ST ADVANCED AGED HUDSON WI 54016 RHONDA SCHILLINGER Gender - Capacity: M/F - 41 (715) 377-0660 NICOLE KAHLER 750 MAIN ST STE 200 Low/High rate: 4,400/5,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: ST CROIX MENDOTA HEIGHTS MN 55118 Initial License: 07/07/2005 PHYSICALLY DISABLED PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 133 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

COMFORTS OF HOME HUDSON II (0014271) HUDSON COH II LLC Type: CBRF HCBS COMPLIANT (651) 287-0265 Class: CNA 805 HEGGEN ST ADVANCED AGED HUDSON WI 54016 RHONDA SCHILLINGER Gender - Capacity: M/F - 40 (715) 386-3324 NICOLE KAHLER 750 MAIN ST STE 200 Low/High rate: 4,600/5,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: ST CROIX MENDOTA HEIGHTS MN 55118 Initial License: 07/01/2012 PHYSICALLY DISABLED PUBLIC FUNDING DEERFIELD (THE) (0008844) PHM NEW RICHMOND SENIOR HOUSING Type: CBRF ADVANCED AGED (715) 243-3900 Class: CNA 1127 WEST EIGHTH STREET IRREVERSIBLE DEMENTIA/ALZHEIM NEW RICHMOND WI 54017 JENNIFER ANDERSON Gender - Capacity: M/F - 17 (715) 243-3900 JENNIFER ANDERSON 1127 WEST EIGHTH STREET Low/High rate: 4,610/6,195 PUBLIC FUNDING County: ST CROIX NEW RICHMOND WI 54017 Initial License: 10/14/1999 Association Approval: WALA EXODUS HOUSE (0012273) LUTHERAN SOC SERV OF WI & UPPER MI INC Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 552-2400 Class: AA 698 BAKER RD CORRECTIONAL CLIENTS HUDSON WI 54016 PAULA UPP Gender - Capacity: M - 12 (715) 386-3015 LYNDA OLSON 3003 N RICHMOND Low/High rate: 2,598/2,598 County: ST CROIX APPLETON WI 54911 Initial License: 03/20/2008 GLENHAVEN INC DBA GRAND OAKS CBRF (0016044) GLENHAVEN INC Type: CBRF ADVANCED AGED (715) 265-4555 Class: CNA 614 E OAK ST 200-215 IRREVERSIBLE DEMENTIA/ALZHEIM GLENWOOD CITY WI 54013 SHERRY GOODMAN Gender - Capacity: M/F - 16 (715) 265-4555 SHERRY GOODMAN 612 E OAK ST Low/High rate: 3,691/4,761 PHYSICALLY DISABLED County: ST CROIX GLENWOOD CITY WI 54013 Initial License: 04/08/2016 TERMINALLY ILL Association Approval: LeadingAge Wisconsin J AND J HILLSIDE HOLLOW LLC (0017073) J AND J HILLSIDE HOLLOW LLC Type: CBRF HCBS COMPLIANT (715) 781-2838 Class: CNA 1606 COUNTY RD X DEVELOPMENTALLY DISABLED GLENWOOD CITY WI 54013 JESSICA KNOPS Gender - Capacity: M/F - 8 (715) 265-0200 JODI/JESSICA MAIN/KNOPS 1606 COUNTY RD X Low/High rate: 3,800/10,000 PHYSICALLY DISABLED County: ST CROIX GLENWOOD CITY WI 54013 Initial License: 07/16/2018 TRAUMATIC BRAIN INJURY KITTY RHOADES MEMORIAL MEMORY CARE CENTER (00 ST CROIX COUNTY Type: CBRF HCBS COMPLIANT (715) 386-4600 Class: CNA 1446 N 4TH STREET ADVANCED AGED NEW RICHMOND WI 54017 SANDY HACKENMUELLER Gender - Capacity: M/F - 10 (715) 246-8211 SANDRA HACKENMUELLER 1445 N 4TH ST Low/High rate: 3,000/10,858 IRREVERSIBLE DEMENTIA/ALZHEIM County: ST CROIX NEW RICHMOND WI 54017 Initial License: 02/28/2017 PHYSICALLY DISABLED ORCHARD VIEW TERRACE (0016719) ST CROIX COUNTY Type: CBRF HCBS COMPLIANT (715) 386-4400 Class: CNA 1423 N 4TH STREET ADVANCED AGED NEW RICHMOND WI 54017 SANDY HACKENMUELLER Gender - Capacity: - 48 (715) 246-8211 SANDRA HACKENMUELLER 1445 N 4TH STREET Low/High rate: 3,250/6,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: ST CROIX NEW RICHMOND WI 54017 Initial License: 08/10/2017 PHYSICALLY DISABLED Association Approval: LeadingAge Wisconsin OUR HOUSE NEW RICHMOND MEMORY CARE (0013427) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 1310 CIRCLE PINE DR ADVANCED AGED NEW RICHMOND WI 54017 LORI NARDIN Gender - Capacity: M/F - 15 (715) 246-7655 LAURA DREIER 4350 156TH STREET Low/High rate: 4,425/4,475 IRREVERSIBLE DEMENTIA/ALZHEIM County: ST CROIX CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING PINE RIDGE ASSISTED LIVING (0012820) CHRISTIAN COMMUNITY HOME OF HUDSON INC Type: CBRF HCBS COMPLIANT (715) 381-4210 Class: CNA 1320 WISCONSIN ST ADVANCED AGED HUDSON WI 54016 JENNIE ORMAN Gender - Capacity: M/F - 40 (715) 386-4539 JENNIE ORMAN 1320 WISCONSIN ST Low/High rate: 3,772/6,783 IRREVERSIBLE DEMENTIA/ALZHEIM County: ST CROIX HUDSON WI 54016 Initial License: 08/01/2009 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin RED CEDAR CANYON ASSISTED LIVING (0013526) RED CEDAR CANYON ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (651) 454-4801 Class: CNA 3001 HANLEY RD ADVANCED AGED HUDSON WI 54016 NED AMMONS Gender - Capacity: M/F - 16 (715) 381-7333 NED AMMONS 3001 HANLEY RD Low/High rate: 3,275/4,030 IRREVERSIBLE DEMENTIA/ALZHEIM County: ST CROIX HUDSON WI 54016 Initial License: 03/28/2011 PUBLIC FUNDING WOODLAND HILL (0016010) HUDSON SENIOR HOUSING LLC Type: CBRF ADVANCED AGED (651) 631-6100 Class: CNA 431 STAGELINE ROAD IRREVERSIBLE DEMENTIA/ALZHEIM HUDSON WI 54016 MARK MEYER Gender - Capacity: M/F - 81 (715) 716-5200 JANEL MILLER 2845 HAMLINE AVENUE NORTH Low/High rate: 3,350/4,700 County: ST CROIX ROSEVILLE MN 55113 Initial License: 06/20/2016

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 134 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ALMOST HOME AGAIN LLC (0013267) ALEXANDRA ELLIS Type: CBRF HCBS COMPLIANT (715) 447-5574 Class: CS N3531 ELDER DR ALCOHOL/DRUG DEPENDENT GILMAN WI 54433 ALEXANDRA ELLIS Gender - Capacity: M/F - 8 (715) 965-1686 ALEXANDRA ELLIS N3531 ELDER DR Low/High rate: 4,732/4,874 CORRECTIONAL CLIENTS County: TAYLOR GILMAN WI 54433 Initial License: 06/07/2010 EMOTIONALLY DISTURBED/MENTAL ASPIRUS CEDAR LANE (610071) ASPIRUS MEDFORD HOSPITAL AND CLINICS INC Type: CBRF ADVANCED AGED (715) 748-8100 Class: CNA 135 SOUTH GIBSON STREET PUBLIC FUNDING MEDFORD WI 54451 MALLORI STRAMA Gender - Capacity: M/F - 10 (715) 748-8100 MALLORI STRAMA 135 SOUTH GIBSON STREET Low/High rate: 3,517/3,587 County: TAYLOR MEDFORD WI 54451 Initial License: 01/01/1981 Association Approval: LeadingAge Wisconsin CARE PARTNERS ASSISTED LIVING MEDFORD (0013863) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 955 E ALLMAN ST ADVANCED AGED MEDFORD WI 54451 JASON LINDEMANN Gender - Capacity: M/F - 18 (715) 748-2114 SHERRY STRASSBURGER PO BOX 3006 Low/High rate: 3,100/4,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: TAYLOR OSHKOSH WI 54903 Initial License: 09/08/2011 TERMINALLY ILL DEERVIEW MEADOWS MEDFORD (0011540) DEERVIEW MEADOWS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (608) 215-4264 Class: CNA 509 LEMKE AVENUE ADVANCED AGED MEDFORD WI 54451 WILLIAM/CHERYL TESNOW Gender - Capacity: M/F - 15 (715) 748-5566 AUDREY HOMER 3579 EDGEWOOD DR. Low/High rate: 3,200/4,300 DEVELOPMENTALLY DISABLED County: TAYLOR MC FARLAND WI 53558 Initial License: 06/20/2006 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL OUR HOUSE MEDFORD ASSISTED CARE (0013429) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 1014 W BROADWAY AVE ADVANCED AGED MEDFORD WI 54451 LORI NARDIN Gender - Capacity: M/F - 21 (715) 748-2901 MAYA WILL 4350 156TH STREET Low/High rate: 3,975/4,175 IRREVERSIBLE DEMENTIA/ALZHEIM County: TAYLOR CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING FAMILY CIRCLE (510123) THERESA OLSON Type: CBRF HCBS COMPLIANT (715) 695-3531 Class: ANA 211 6TH AVE N PO BOX 187 ADVANCED AGED STRUM WI 54770 THERESA OLSON Gender - Capacity: M - 16 (715) 695-3531 THERESA OLSON PO BOX 187 Low/High rate: 1,142/2,000 ALCOHOL/DRUG DEPENDENT County: TREMPEALEAU STRUM WI 54770 Initial License: 06/15/1989 EMOTIONALLY DISTURBED/MENTAL FARNAM COMMUNITY LIVING CENTER (510103) TREMPEALEAU COUNTY HEALTH CARE CENTER Type: CBRF HCBS COMPLIANT (715) 538-4312 Class: CS 18425 DODGE ST EMOTIONALLY DISTURBED/MENTAL WHITEHALL WI 54773 SHELLY RIETMANN Gender - Capacity: M/F - 16 (715) 538-4518 SHELLY RIETMANN 18425 DODGE STREET Low/High rate: 3,400/3,500 PUBLIC FUNDING County: TREMPEALEAU WHITEHALL WI 54773 Initial License: 01/23/1980 Association Approval: LeadingAge Wisconsin GRAND AVENUE ASSISTED LIVING (0017201) GRAND VIEW HOME INC Type: CBRF ADVANCED AGED (608) 989-2511 Class: CNA 620 GRAND VIEW AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM BLAIR WI 54616 STACY KOPP Gender - Capacity: M/F - 12 (608) 989-2511 STACY KOPP PO BOX 27 Low/High rate: 3,400/4,200 PHYSICALLY DISABLED County: TREMPEALEAU BLAIR WI 54616 Initial License: 08/01/2018 TERMINALLY ILL OVER THE RIVER LLC (0017978) OVER THE RIVER LLC Type: CBRF ADVANCED AGED (608) 769-2872 Class: AA 24616 SECOND STREET IRREVERSIBLE DEMENTIA/ALZHEIM TREMPEALEAU WI 54661 NANCY BOEHM Gender - Capacity: M/F - 8 (608) 534-2105 NANCY BOEHM 24616 SECOND STREET Low/High rate: 2,500/5,995 County: TREMPEALEAU TREMPEALEAU WI 54661 Initial License: 07/01/2020 ROLLING MEADOWS OF STRUM (0017970) STRUM RESIDENCE LLC Type: CBRF HCBS COMPLIANT (630) 974-9515 Class: CNA 208 ELM STREET ADVANCED AGED STRUM WI 54770 DENNIS PARAGAS Gender - Capacity: M/F - 19 (630) 974-9515 BRENDA WILLIAMS 208 ELM STREET PO BOX 182 Low/High rate: 3,800/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: TREMPEALEAU STRUM WI 54770 Initial License: 10/12/2020 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 135 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

WILLOW BROOK COMMUNITY BASED RESIDENTIAL FACI TREMPEALEAU COUNTY HEALTH CARE CENTER Type: CBRF HCBS COMPLIANT (715) 538-4518 Class: CS N36655 COUNTY ROAD QQQ ALCOHOL/DRUG DEPENDENT WHITEHALL WI 54773 SHELLY RIETMANN Gender - Capacity: M/F - 15 (715) 538-4518 SHELLY RIETMANN 18425 DODGE STREET Low/High rate: 3,450/6,900 DEVELOPMENTALLY DISABLED County: TREMPEALEAU WHITEHALL WI 54773 Initial License: 07/29/2020 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED Association Approval: LeadingAge Wisconsin WILLOW RIDGE COMMUNITY BASED RESIDENTIAL FACIL TREMPEALEAU COUNTY HEALTH CARE CENTER Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 538-4518 Class: CS N36585 COUNTY ROAD QQQ DEVELOPMENTALLY DISABLED WHITEHALL WI 54773 SHELLY RIETMANN Gender - Capacity: M/F - 15 (715) 538-4518 SHELLY RIETMANN 18425 DODGE STREET Low/High rate: 3,450/6,900 EMOTIONALLY DISTURBED/MENTAL County: TREMPEALEAU WHITEHALL WI 54773 Initial License: 12/30/2020 PHYSICALLY DISABLED BETHEL OAKS MEMORY CARE HOME (0015739) BETHEL HOME AND SERVICES, INC Type: CBRF HCBS COMPLIANT (608) 637-2171 Class: CNA 620 S GARFIELD AVENUE SUITE A IRREVERSIBLE DEMENTIA/ALZHEIM VIROQUA WI 54665 DEBRA K STOUT TEWALT Gender - Capacity: M/F - 29 (608) 637-2171 DEBRA STOUT TEWALT 614 S ROCK AVENUE Low/High rate: 3,900/4,731 County: VERNON VIROQUA WI 54665 Initial License: 07/20/2015 Association Approval: LeadingAge Wisconsin CHURCH ST HOUSE (0017389) WINDY RIDGE CARE INC Type: CBRF HCBS COMPLIANT (608) 343-1177 Class: ANA 207 CHURCH ST ALCOHOL/DRUG DEPENDENT ONTARIO WI 54651 GLORIA DIPPEN Gender - Capacity: M/F - 8 (608) 343-1177 GLORIA DIPPEN PO BOX 126 Low/High rate: 4,000/8,000 DEVELOPMENTALLY DISABLED County: VERNON WILTON WI 54670 Initial License: 12/21/2018 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CREAMERY CREEK (0016504) VIROQUA CBRF LLC Type: CBRF ADVANCED AGED (608) 638-1600 Class: CNA 1049 CHICAGO AVE IRREVERSIBLE DEMENTIA/ALZHEIM VIROQUA WI 54665 MIKE TULLY Gender - Capacity: M/F - 39 (608) 638-1600 TINA DAHL 201 N PEARL ST Low/High rate: 4,000/6,500 County: VERNON STODDARD WI 54658 Initial License: 02/06/2017 LAFARGE AREA SENIOR CONCERNS BETHEL PARKSIDE BETHEL HOME & SERVICES INC Type: CBRF HCBS COMPLIANT (608) 637-2171 Class: CNA 315 WEST ADAMS COURT ADVANCED AGED LA FARGE WI 54639 DEBRA STOUT TEWALT Gender - Capacity: M/F - 8 (608) 625-2308 DEBRA STOUT TEWALT 614 SOUTH ROCK AVE Low/High rate: 3,802/2,085 DEVELOPMENTALLY DISABLED County: VERNON VIROQUA WI 54665 Initial License: 02/15/1996 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin MILESTONE SENIOR LIVING HILLSBORO CBRF (0017061) ABILIT HOLDINGS HILLSBORO LLC Type: CBRF ADVANCED AGED (858) 500-6793 Class: CNA 504 SALSBERY CIRCLE IRREVERSIBLE DEMENTIA/ALZHEIM HILLSBORO WI 54634 KAREN SCHACHT Gender - Capacity: M/F - 18 (608) 489-3932 BRIDGET PHILLIPS 328 NATURE PLACE Low/High rate: 4,500/7,500 County: VERNON JOHNSON CREEK WI 53038 Initial License: 05/18/2018 SHERRY HOUSE (THE) (510352) ASSISTED CARE INC Type: CBRF HCBS COMPLIANT (608) 634-2169 Class: AA 440 EAST CENTER STREET DEVELOPMENTALLY DISABLED READSTOWN WI 54652 VERNEL VESBACH Gender - Capacity: M/F - 8 (608) 629-5150 MELISSA PETERSON E8871 REO AVE Low/High rate: 3,770/5,338 EMOTIONALLY DISTURBED/MENTAL County: VERNON WESTBY WI 54667 Initial License: 12/16/1996 VERNON AREA REHAB CENTER INC CBRF (510340) VERNON AREA REHAB CENTER INC Type: CBRF HCBS COMPLIANT (608) 637-3934 Class: CNA 811 ROGERS ST DEVELOPMENTALLY DISABLED VIROQUA WI 54665 ELIZABETH FILTER Gender - Capacity: M/F - 8 (608) 637-2353 NIKI STEELE 1133 NELSON PARKWAY Low/High rate: 2,020/5,837 PUBLIC FUNDING County: VERNON VIROQUA WI 54665 Initial License: 01/01/1985 VIOLA HOUSE (THE) (0008941) ASSISTED CARE INC Type: CBRF HCBS COMPLIANT (608) 634-2169 Class: CNA 509 S WAGONER STREET DEVELOPMENTALLY DISABLED VIOLA WI 54664-8506 VERNEL VESBACH Gender - Capacity: M/F - 8 (608) 627-1111 MELISSA PETERSON E8871 REO AVENUE Low/High rate: 3,640/4,030 EMOTIONALLY DISTURBED/MENTAL County: VERNON WESTBY WI 54667 Initial License: 02/03/2000

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 136 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

A HOME IN THE NORTHWOODS LLC (0014143) A HOME IN THE NORTHWOODS LLC Type: CBRF ADVANCED AGED (715) 337-2035 Class: CNA 717 INDIANA STREET IRREVERSIBLE DEMENTIA/ALZHEIM EAGLE RIVER WI 54521 DIANNE HERR Gender - Capacity: M/F - 15 (715) 337-2035 MICHAEL HERR 717 INDIANA STREET Low/High rate: 2,800/4,800 TERMINALLY ILL County: VILAS EAGLE RIVER WI 54521 Initial License: 07/02/2012 A HOME IN THE NORTHWOODS LLC (0014143) A HOME IN THE NORTHWOODS LLC Type: CBRF ADVANCED AGED (715) 337-2035 Class: CNA 717 INDIANA STREET IRREVERSIBLE DEMENTIA/ALZHEIM EAGLE RIVER WI 54521 DIANNE HERR Gender - Capacity: M/F - 15 (715) 337-2035 MICHAEL HERR 717 INDIANA STREET Low/High rate: 2,800/4,800 TERMINALLY ILL County: VILAS EAGLE RIVER WI 54521 Initial License: 07/02/2012 GOOKOMIS ENDAAD (0015826) LAC DU FLAMBEAU BAND OF LAKE SUPERIOR C Type: CBRF ALCOHOL/DRUG DEPENDENT (715) 588-4422 Class: ANA 3378 N SCHILLEMAN ROAD CORRECTIONAL CLIENTS LAC DU FLAMBEAU WI 54538 PATRICIA THOMPSON Gender - Capacity: M/F - 20 (715) 588-4422 PATRICIA THOMPSON PO BOX 815 Low/High rate: 450/10,500 County: VILAS LAC DU FLAMBEAU WI 54538 Initial License: 01/19/2016 LAKE SHORE ASSISTED LIVING BOLTON COTTAGE (0016 LAKE SHORE ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 331-9148 Class: CNA 2201 W BOLTON LAKE LN ADVANCED AGED LAC DU FLAMBEAU WI 54538 HEATHER FISHLEIGH Gender - Capacity: M/F - 8 (715) 588-9222 HEATHER FISHLEIGH 12440 WARPATH LN Low/High rate: 3,100/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: VILAS MINOCQUA WI 54548 Initial License: 01/09/2017 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY LAKE SHORE ASSISTED LIVING CEDAR COTTAGE (00164 LAKE SHORE ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 331-9148 Class: CNA 12440 WARPATH LN ADVANCED AGED MINOCQUA WI 54548 HEATHER FISHLEIGH Gender - Capacity: M/F - 15 (715) 356-2911 HEATHER FISHLEIGH 12440 WARPATH LN Low/High rate: 3,100/6,000 DEVELOPMENTALLY DISABLED County: VILAS MINOCQUA WI 54548 Initial License: 01/06/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED LAKE SHORE ASSISTED LIVING SPRUCE COTTAGE (0016 LAKE SHORE ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 331-9148 Class: CNA 12440 WARPATH LN ADVANCED AGED MINOCQUA WI 54548 HEATHER FISHLEIGH Gender - Capacity: M/F - 8 (715) 356-2911 HEATHER FISHLEIGH 12440 WARPATH LN Low/High rate: 3,100/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: VILAS MINOCQUA WI 54548 Initial License: 01/06/2017 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY MILESTONE SENIOR LIVING RAILROAD CBRF (0017054) ABILIT HOLDINGS EAGLE RIVER LLC Type: CBRF ADVANCED AGED (858) 500-6793 Class: CNA 2332 RAILROAD ST HWY 45N IRREVERSIBLE DEMENTIA/ALZHEIM EAGLE RIVER WI 54521 AMY LEMKE Gender - Capacity: M/F - 21 (715) 479-8018 BETH ANN MONTEZON 208 35TH ST DR SE STE 500 Low/High rate: 4,500/7,500 County: VILAS CEDAR RAPIDS IA 52403-1361 Initial License: 05/18/2018 PHELPS CARE WI LLC (0014549) PHELPS CARE WI LLC Type: CBRF HCBS COMPLIANT (847) 305-2103 Class: CNA 4288 S MAPLE RD ADVANCED AGED PHELPS WI 54554 ELIZABETH OSLAKOVICH Gender - Capacity: M/F - 15 (715) 545-3144 ELIZABETH OSLAKOVICH 4288 S MAPLE ROAD Low/High rate: 3,300/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: VILAS PHELPS WI 54554 Initial License: 03/19/2013 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL BOULEVARD MANOR (310316) BOULEVARD MANOR LLC Type: CBRF ADVANCED AGED (262) 248-8195 Class: CA 945 LAKE GENEVA BLVD DEVELOPMENTALLY DISABLED LAKE GENEVA WI 53147 ERIC KLUG Gender - Capacity: M/F - 8 (262) 248-8195 LAURA BROTEN 945 LAKE GENEVA BLVD Low/High rate: 2,200/2,200 EMOTIONALLY DISTURBED/MENTAL County: WALWORTH LAKE GENEVA WI 53147 Initial License: 12/13/1982 PHYSICALLY DISABLED

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 137 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BURR OAK MANOR INC (310321) BURR OAK MANOR INC Type: CBRF HCBS COMPLIANT (262) 279-9990 Class: CNA 264 WALWORTH ST ADVANCED AGED GENOA CITY WI 53128 PAMELA PREDICK Gender - Capacity: M/F - 33 (262) 279-9990 PAMELA PREDICK PO BOX 304 Low/High rate: 4,300/7,800 DEVELOPMENTALLY DISABLED County: WALWORTH DELAVAN WI 53115 Initial License: 07/01/1995 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY BURR OAK MANOR INC (310321) BURR OAK MANOR INC Type: CBRF HCBS COMPLIANT (262) 279-9990 Class: CNA 264 WALWORTH ST ADVANCED AGED GENOA CITY WI 53128 PAMELA PREDICK Gender - Capacity: M/F - 33 (262) 279-9990 PAMELA PREDICK PO BOX 304 Low/High rate: 4,300/7,800 DEVELOPMENTALLY DISABLED County: WALWORTH DELAVAN WI 53115 Initial License: 07/01/1995 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY CASA MIA CARE CENTER (310324) CASA MIA CARE CENTER INC Type: CBRF HCBS COMPLIANT (262) 279-6505 Class: AA W1043 ROSEWOOD RD DEVELOPMENTALLY DISABLED GENOA CITY WI 53128 RENEE BROWN Gender - Capacity: M/F - 15 (262) 279-6505 RENEE BROWN PO BOX 292 Low/High rate: 2,265/5,629 EMOTIONALLY DISTURBED/MENTAL County: WALWORTH PELL LAKE WI 53157 Initial License: 07/01/1982 PUBLIC FUNDING COBBLESTONES (0013075) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: AS 4492 COBBLESTONES RD ALCOHOL/DRUG DEPENDENT DELAVAN WI 53115 CHRISTOPHER COHEN Gender - Capacity: M/F - 6 (262) 740-0111 Dennis Patterson 209 S TAFT ST Low/High rate: 4,563/9,125 DEVELOPMENTALLY DISABLED County: WALWORTH WHITEWATER WI 53190 Initial License: 01/01/2010 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY FAIRHAVEN (310378) FAIRHAVEN CORPORATION Type: CBRF HCBS COMPLIANT (262) 473-2140 Class: ANA 435 W STARIN RD ADVANCED AGED WHITEWATER WI 53190-1125 Peterson Linda Gender - Capacity: M/F - 150 (262) 473-2140 Paul Kuenning 435 W STARIN RD Low/High rate: 712/7,725 PUBLIC FUNDING County: WALWORTH WHITEWATER WI 53190-1125 Initial License: 06/01/1980 Association Approval: LeadingAge Wisconsin GARDENS AT RIDGESTONE LLC (THE) (0015097) THE GARDENS AT RIDGESTONE LLC Type: CBRF HCBS COMPLIANT (262) 743-2960 Class: CNA 233 W EVERGREEN PKWY ADVANCED AGED ELKHORN WI 53121 CHRISTINA KIESEL Gender - Capacity: M/F - 32 (262) 743-2960 CHRISTINA KIESEL 291 W EVERGREEN PKWY Low/High rate: 4,250/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WALWORTH ELKHORN WI 53121 Initial License: 07/10/2014 PUBLIC FUNDING GLENWOOD AT MULBERRY (0017288) CHIARA COMMUNITIES INC Type: CBRF ADVANCED AGED (262) 798-1224 Class: CNA 1281 W MAIN ST IRREVERSIBLE DEMENTIA/ALZHEIM WHITEWATER WI 53190 GLEN CHOBAN Gender - Capacity: M/F - 23 (262) 473-9876 CHAD MURPHY 20875 CROSSROADS CIR STE 400 Low/High rate: 4,850/6,100 PHYSICALLY DISABLED County: WALWORTH WAUKESHA WI 53186 Initial License: 11/01/2018 TERMINALLY ILL GOLDEN YEARS ASSISTED LIVING RESIDENCE (310402) GOLDEN YEARS NURSING HOME INC Type: CBRF ADVANCED AGED (262) 275-6103 Class: CNA 270 RIDGE RD IRREVERSIBLE DEMENTIA/ALZHEIM WALWORTH WI 53184 jon Stankevitz Gender - Capacity: M/F - 26 (262) 275-6103 Hannah Campbell 270 RIDGE RD Low/High rate: 4,110/7,865 TERMINALLY ILL County: WALWORTH WALWORTH WI 53184 Initial License: 04/19/1993 HEARTHSTONE (310689) FAIRHAVEN CORPORATION Type: CBRF HCBS COMPLIANT (262) 473-2140 Class: CNA 426 W NORTH ST IRREVERSIBLE DEMENTIA/ALZHEIM WHITEWATER WI 53190 LYNN BINNIE Gender - Capacity: M/F - 24 (262) 473-2140 Paul Kuenning 435 STARIN RD Low/High rate: 6,323/7,235 PUBLIC FUNDING County: WALWORTH WHITEWATER WI 53190 Initial License: 02/02/1998 Association Approval: LeadingAge Wisconsin *The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 138 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

INSPIRATION MINISTRIES (310343) CHRISTIAN LEAGUE FOR THE HANDICAPPED IN Type: CBRF HCBS COMPLIANT (262) 275-6131 Class: CNA N2270 HWY 67 DEVELOPMENTALLY DISABLED WALWORTH WI 53184 Erik Barber Gender - Capacity: M/F - 20 (262) 275-6131 Erik Barber PO BOX 948 Low/High rate: 1,855/6,075 PHYSICALLY DISABLED County: WALWORTH WALWORTH WI 53184 Initial License: 09/01/1986 TRAUMATIC BRAIN INJURY INSPIRATION MINISTRIES (310343) CHRISTIAN LEAGUE FOR THE HANDICAPPED IN Type: CBRF HCBS COMPLIANT (262) 275-6131 Class: CNA N2270 HWY 67 DEVELOPMENTALLY DISABLED WALWORTH WI 53184 Erik Barber Gender - Capacity: M/F - 20 (262) 275-6131 Erik Barber PO BOX 948 Low/High rate: 1,855/6,075 PHYSICALLY DISABLED County: WALWORTH WALWORTH WI 53184 Initial License: 09/01/1986 TRAUMATIC BRAIN INJURY Association Approval: WALA JADE HOUSE (310430) PRODUCTIVE LIVING SYSTEMS INC Type: CBRF DEVELOPMENTALLY DISABLED (715) 831-3910 Class: AA 1541 W WALWORTH AVE EMOTIONALLY DISTURBED/MENTAL WHITEWATER WI 53190 Productive Living Systems Gender - Capacity: M/F - 8 (262) 473-4447 Thomas Hastreiter 806 E COMMERCIAL AVE Low/High rate: 4,535/4,535 TRAUMATIC BRAIN INJURY County: WALWORTH WHITEWATER WI 53190 Initial License: 02/07/1989 JUST LIKE HOME IV (0010103) JUST LIKE HOME IV Type: CBRF HCBS COMPLIANT (262) 742-4930 Class: CNA W5140 HWY A ADVANCED AGED ELKHORN WI 53121 DAVID DEIHS Gender - Capacity: M/F - 16 (262) 742-4931 Hoss Rehberg W5140 HWY A Low/High rate: 2,800/5,200 DEVELOPMENTALLY DISABLED County: WALWORTH ELKHORN WI 53121 Initial License: 09/24/2003 EMOTIONALLY DISTURBED/MENTAL JUST LIKE HOME V (0015073) JUST LIKE HOME V Type: CBRF ADVANCED AGED (262) 649-6339 Class: CNA W5140 COUNTY ROAD A UNIT 1 DEVELOPMENTALLY DISABLED ELKHORN WI 53121 DAVID DEIHS Gender - Capacity: M/F - 8 (262) 742-4930 Hoss Rehberg W5140 COUNTY ROAD A UNIT 1 Low/High rate: 3,200/4,800 EMOTIONALLY DISTURBED/MENTAL County: WALWORTH ELKHORN WI 53121 Initial License: 06/27/2014 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY KETTLE VIEW (0013068) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: AS N8603 DUFFIN RD DEVELOPMENTALLY DISABLED WHITEWATER WI 53190 CHRISTOPHER COHEN Gender - Capacity: M/F - 8 (262) 495-2676 Dennis Patterson 209 S TAFT ST Low/High rate: 4,563/9,125 EMOTIONALLY DISTURBED/MENTAL County: WALWORTH WHITEWATER WI 53190 Initial License: 01/01/2010 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY KIMBERLY LANE CBRF (310437) SONJA NOTTELSON Type: CBRF HCBS COMPLIANT (414) 378-3920 Class: AS 416 KIMBERLY LN DEVELOPMENTALLY DISABLED ELKHORN WI 53121 SONJA NOTTELSON Gender - Capacity: M/F - 6 (262) 723-8077 ADAM ROSS 104 LAZY LAKE DR Low/High rate: 3,397/3,545 PUBLIC FUNDING County: WALWORTH FALL RIVER WI 53932 Initial License: 11/11/1991 KINDREDHEARTS OF ELKHORN (0010415) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 450 E GENEVA ST ADVANCED AGED ELKHORN WI 53121 DOUGLAS HENNIG Gender - Capacity: M/F - 20 (262) 723-8400 MARY HOBBS 450 E GENEVA ST Low/High rate: 3,504/5,612 IRREVERSIBLE DEMENTIA/ALZHEIM County: WALWORTH ELKHORN WI 53121 Initial License: 10/24/2003 PUBLIC FUNDING LAURAS HOME (310450) LAURA'S HOME LLC Type: CBRF HCBS COMPLIANT (262) 903-2624 Class: CNA 945 LAKE GENEVA BLVD ADVANCED AGED LAKE GENEVA WI 53147 MARC KLUG Gender - Capacity: M/F - 8 (262) 248-9798 LAURA BROTEN 945 LAKE GENEVA BLVD Low/High rate: 2,400/6,000 DEVELOPMENTALLY DISABLED County: WALWORTH LAKE GENEVA WI 53147 Initial License: 11/03/1990 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY OUR HOUSE WHITEWATER MEMORY CARE (0013384) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 945 E CHICAGO ST ADVANCED AGED WHITEWATER WI 53190 LORI NARDIN Gender - Capacity: M/F - 20 (262) 473-1011 Daylene Puckett 4350 156th ST Low/High rate: 3,999/4,925 IRREVERSIBLE DEMENTIA/ALZHEIM County: WALWORTH CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 139 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PINECREST (0013737) SCOTT CHAPPELL Type: CBRF HCBS COMPLIANT (414) 708-5407 Class: CNA N3367 CTY RD NN ADVANCED AGED LAKE GENEVA WI 53147 SCOTT CHAPPELL Gender - Capacity: M/F - 12 (262) 249-8900 SCOTT CHAPPELL N3367 CTY RD NN Low/High rate: 3,100/3,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WALWORTH LAKE GENEVA WI 53147 Initial License: 08/08/2011 PHYSICALLY DISABLED PUBLIC FUNDING RIDGESTONE VILLAGE LTD (310698) RIDGESTONE VILLAGE LTD Type: CBRF ADVANCED AGED (262) 728-2848 Class: CNA 1025 S SECOND ST IRREVERSIBLE DEMENTIA/ALZHEIM DELAVAN WI 53115 CHRISTINA KIESEL Gender - Capacity: M/F - 20 (262) 728-2848 CHRISTINA KIESEL 1025 S SECOND ST Low/High rate: 3,800/4,200 PHYSICALLY DISABLED County: WALWORTH DELAVAN WI 53115 Initial License: 07/01/1998 PUBLIC FUNDING TERMINALLY ILL ROSEWOOD MANOR LLC (0009613) ROSEWOOD MANOR LLC Type: CBRF HCBS COMPLIANT (262) 728-7673 Class: CNA 2220 BORG RD ADVANCED AGED DELAVAN WI 53115 PAMELA PREDICK Gender - Capacity: M/F - 8 (262) 728-7673 PAMELA PREDICK PO BOX 564 Low/High rate: 3,200/6,200 DEVELOPMENTALLY DISABLED County: WALWORTH DELAVAN WI 53115 Initial License: 07/15/2002 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY ROSEWOOD MANOR LLC (0009613) ROSEWOOD MANOR LLC Type: CBRF HCBS COMPLIANT (262) 728-7673 Class: CNA 2220 BORG RD ADVANCED AGED DELAVAN WI 53115 PAMELA PREDICK Gender - Capacity: M/F - 8 (262) 728-7673 PAMELA PREDICK PO BOX 564 Low/High rate: 3,200/6,200 DEVELOPMENTALLY DISABLED County: WALWORTH DELAVAN WI 53115 Initial License: 07/15/2002 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY SUNNYSIDE HOME (310561) SUNNYSIDE HOME INC Type: CBRF HCBS COMPLIANT (262) 723-4175 Class: AS 1 EASTOWN MANOR ADVANCED AGED ELKHORN WI 53121 HOSS REHBERG Gender - Capacity: M/F - 8 (262) 723-4175 DAVID DIEHS 1 EASTOWN MANOR Low/High rate: 3,300/7,500 DEVELOPMENTALLY DISABLED County: WALWORTH ELKHORN WI 53121 Initial License: 02/01/1985 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING VILLAGE GLEN OF GENEVA CROSSING (0009329) LAKE GENEVA ASSISTED LIVING OPERATING CO Type: CBRF HCBS COMPLIANT (262) 248-4558 Class: CNA 723 S CURTIS ST ADVANCED AGED LAKE GENEVA WI 53147 ANDY KERWIN Gender - Capacity: M/F - 18 (262) 248-4558 Andrew Kerwin 201 TOWNLINE ROAD Low/High rate: 4,900/5,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WALWORTH LAKE GENEVA WI 53147 Initial License: 07/10/2001 TERMINALLY ILL VINTAGE ON THE PONDS (0018011) VINTAGE FAMILY INVESTMENTS I LLC Type: CBRF HCBS COMPLIANT (262) 728-2171 Class: CNA N4901 DAM ROAD ADVANCED AGED DELAVAN WI 53115 VICKI ZWIEG Gender - Capacity: M/F - 70 (262) 728-2171 VICKI ZWIEG N4901 DAM ROAD Low/High rate: 2,935/9,385 IRREVERSIBLE DEMENTIA/ALZHEIM County: WALWORTH DELAVAN WI 53115 Initial License: 10/29/2020 WHISPERING WILLOWS (310585) WHISPERING WILLOWS INC Type: CBRF HCBS COMPLIANT (262) 723-7388 Class: ANA W4517 WILLOW BEND RD ADVANCED AGED ELKHORN WI 53121 CONNIE PALMER Gender - Capacity: M/F - 11 (262) 723-7388 CONNIE PALMER W4211 PALMER RD Low/High rate: 2,500/3,600 County: WALWORTH LAKE GENEVA WI 53147 Initial License: 06/17/1991 CARE PARTNERS ASSISTED LIVING LLC (0009048) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (920) 232-1672 Class: CNA W7184 GREEN VALLEY RD IRREVERSIBLE DEMENTIA/ALZHEIM SPOONER WI 54801 JASON E LINDEMANN Gender - Capacity: M/F - 15 (715) 635-9211 TABITHA KESSINGER P O BOX 3006 Low/High rate: 3,500/5,200 PHYSICALLY DISABLED County: WASHBURN OSHKOSH WI 54903 Initial License: 06/01/2000 TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 140 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

COUNTRY TERRACE SPOONER (0011535) COUNTRY TERRACE OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA N4810 HILL DR ADVANCED AGED SPOONER WI 54801 JASON LINDEMANN Gender - Capacity: M/F - 18 (715) 635-3908 TABITHA KESSINGER P O BOX 3006 Low/High rate: 2,810/3,850 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHBURN OSHKOSH WI 54903 Initial License: 07/14/2006 PHYSICALLY DISABLED TERMINALLY ILL GLENVIEW SPECIAL CARE WING (0012418) TH INC Type: CBRF HCBS COMPLIANT (715) 468-4255 Class: CNA 201 GLENVIEW LANE ADVANCED AGED SHELL LAKE WI 54871 JOANN HOLMBERG Gender - Capacity: M/F - 12 (715) 468-4255 JOANN HOLMBERG 201 GLENVIEW LANE Low/High rate: 4,075/4,875 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHBURN SHELL LAKE WI 54871 Initial License: 05/29/2008 PUBLIC FUNDING VILLAS AT MAPLE RIDGE (THE) (0016828) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF ADVANCED AGED (303) 980-0611 Class: CNA 819 ASH STREET IRREVERSIBLE DEMENTIA/ALZHEIM SPOONER WI 54801 JENNIFER ABERNATHY Gender - Capacity: M/F - 14 (715) 939-1759 TALIA BENJAMIN 819 ASH STREET Low/High rate: 3,000/3,900 TERMINALLY ILL County: WASHBURN SPOONER WI 54801 Initial License: 01/09/2018 ARBOR POINT CBRF (0014764) BRIDGES OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (262) 338-4941 Class: CNA 230 232 ARBOR POINT AVE DEVELOPMENTALLY DISABLED WEST BEND WI 53095 KATHY MCCARDELL Gender - Capacity: M/F - 6 (262) 338-4941 KATHLEEN MCCARDELL 1625 E WASHINGTON ST STE 111 Low/High rate: 5,400/6,386 EMOTIONALLY DISTURBED/MENTAL County: WASHINGTON WEST BEND WI 53095 Initial License: 10/07/2013 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY AUTUMN OAKS (0016717) AUTUMN OAKS PLATINUM LLC Type: CBRF HCBS COMPLIANT (414) 940-6608 Class: CNA 227 E WASHINGTON STREET ADVANCED AGED SLINGER WI 53086 JOHN TERESINSKI Gender - Capacity: M/F - 35 (262) 644-5926 TARONDA OLLIE 2448 S 102ND STREET #305 Low/High rate: 2,600/4,500 DEVELOPMENTALLY DISABLED County: WASHINGTON WEST ALLIS WI 53227 Initial License: 08/07/2017 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CALM HARBOR (0014975) ELEVATE INC Type: CBRF ALCOHOL/DRUG DEPENDENT (262) 677-2216 Class: AA 141 S 8TH AVE EMOTIONALLY DISTURBED/MENTAL WEST BEND WI 53095 MARY SIMON Gender - Capacity: M/F - 8 (262) 338-6070 MARK STEIER N169W21005 MEADOW LN Low/High rate: 5,185/5,185 County: WASHINGTON JACKSON WI 53037 Initial License: 03/31/2014 CARRIE LANE HOUSE (0013172) TOUCHSTONE LIVING CARE LLC Type: CBRF HCBS COMPLIANT (262) 412-4002 Class: CNA 1707 CARRIE LN ADVANCED AGED WEST BEND WI 53095 ROBERT TURNER Gender - Capacity: M/F - 8 (262) 353-3278 ROBERT TURNER JR W 5057 Farm Village Low/High rate: 5,500/7,300 DEVELOPMENTALLY DISABLED County: WASHINGTON Elhorn WI 53121 Initial License: 03/04/2010 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CHESTNUT CBRF (0015075) BRIDGES OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (262) 338-4941 Class: CNA 346 S MAIN ST DEVELOPMENTALLY DISABLED WEST BEND WI 53095 KATHY MCCARDELL Gender - Capacity: M/F - 8 (262) 338-4941 KATHLEEN MCCARDELL 1625 E WASHINGTON ST STE 111 Low/High rate: 4,500/5,060 EMOTIONALLY DISTURBED/MENTAL County: WASHINGTON WEST BEND WI 53095 Initial License: 05/13/2014 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY COMPASSIONATE HEIGHTS (0017719) DANKER INC Type: CBRF HCBS COMPLIANT () - Class: CNA 1937 NORTH MAIN STREET ADVANCED AGED WEST BEND WI 53090 DANIELLE BEINING Gender - Capacity: M/F - 8 DANIELLE BEINING 1937 NORTH MAIN STREET Low/High rate: 0/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53090 Initial License: 11/01/2019 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 141 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CORNERSTONE (THE) (0016530) MT TRINITY MANAGEMENT LLC Type: CBRF ADVANCED AGED (262) 689-9725 Class: CNA 330 ARBOR POINT AVE IRREVERSIBLE DEMENTIA/ALZHEIM WEST BEND WI 53095 TINA THULL Gender - Capacity: M/F - 12 (262) 689-9725 DANA LEMMER 8735 HWY HH Low/High rate: 4,500/6,500 PHYSICALLY DISABLED County: WASHINGTON KEWASKUM WI 53040 Initial License: 03/13/2017 TERMINALLY ILL CORNERSTONE II (THE) (0016989) MT TRINITY MANAGEMENT LLC Type: CBRF ADVANCED AGED (262) 689-9725 Class: CNA 330 ARBORPOINT AVE IRREVERSIBLE DEMENTIA/ALZHEIM WEST BEND WI 53095 TINA THULL Gender - Capacity: M/F - 12 (262) 429-1777 DANA LEMMER 8735 HWY H H Low/High rate: 4,800/6,500 PHYSICALLY DISABLED County: WASHINGTON KEWASKUM WI 53040 Initial License: 10/03/2018 TERMINALLY ILL COTTAGES AT CEDAR RUN THE (0015048) BENEVOLENT CORPORATION CEDAR COMMUN Type: CBRF ADVANCED AGED (262) 306-2100 Class: CNA 6090 SCENIC DR IRREVERSIBLE DEMENTIA/ALZHEIM WEST BEND WI 53095 JENNIFER FULLHART Gender - Capacity: M/F - 66 (262) 306-2100 JENNIFER FULLHART 5595 CO RD Z Low/High rate: 6,650/7,400 County: WASHINGTON WEST BEND WI 53095 Initial License: 07/15/2014 Association Approval: LeadingAge Wisconsin ELLENS HOME GERMANTOWN (0012364) ELLENS HOME OF GERMANTOWN LLC Type: CBRF HCBS COMPLIANT (414) 531-2672 Class: CNA N113 W16358 SYLVAN CIR ADVANCED AGED GERMANTOWN WI 53022 BONNIE SANFELIPPO Gender - Capacity: M/F - 20 (262) 250-6455 BONNIE SANFELIPPO 4780 BIRCHWOOD TRL Low/High rate: 4,000/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53095 Initial License: 09/30/2008 PUBLIC FUNDING ELLENS HOME SOUTH (0014373) ELLENS HOME OF GERMANTOWN LLC Type: CBRF HCBS COMPLIANT (414) 531-2672 Class: CNA W150N11127 FOND DU LAC ADVANCED AGED GERMANTOWN WI 53022 BONNIE SANFELIPPO Gender - Capacity: M/F - 46 (414) 640-5715 BONNIE SANFELIPPO 4780 BIRCHWOOD TRL Low/High rate: 4,000/6,000 DEVELOPMENTALLY DISABLED County: WASHINGTON WEST BEND WI 53095 Initial License: 01/29/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY EXODUS TRANSITIONAL CARE FACILITY (310376) EXODUS TRANSITIONAL CARE FAC INC Type: CBRF ALCOHOL/DRUG DEPENDENT 1421 FOND DU LAC AVE (262) 626-4166 Class: AS KEWASKUM WI 53040 CHERYL COLWIN Gender - Capacity: M - 20 (262) 626-4166 CHERYL COLWIN 1421 FOND DU LAC AVE Low/High rate: 3,045/3,045 County: WASHINGTON KEWASKUM WI 53040 Initial License: 06/01/1980 FAIRWAY KNOLL (0017410) PHW GERMANTOWN INC D/B/A FAIRWAY KNOLL Type: CBRF ADVANCED AGED (262) 735-7902 Class: CNA N112W17500 MEQUON ROAD IRREVERSIBLE DEMENTIA/ALZHEIM GERMANTOWN WI 53022 HALLE MUCHE Gender - Capacity: M/F - 20 (262) 735-7902 HALLE MUCHE N112W17500 MEQUON ROAD Low/High rate: 5,400/8,370 County: WASHINGTON GERMANTOWN WI 53022 Initial License: 02/11/2019 Association Approval: LeadingAge Wisconsin FIELDS OF WASHINGTON COUNTY THE (0012737) WASHINGTON COUNTY Type: CBRF ADVANCED AGED () - Class: CNA 531 E WASHINGTON ST IRREVERSIBLE DEMENTIA/ALZHEIM WEST BEND WI 53095 KENDALL PFEIFER Gender - Capacity: M/F - 31 (262) 365-6503 KENDALL PFEIFER 531 E WASHINGTON ST Low/High rate: 4,979/6,705 PUBLIC FUNDING County: WASHINGTON WEST BEND WI 53095 Initial License: 07/29/2009 Association Approval: LeadingAge Wisconsin FOREST VIEW MANOR (0017400) NOHC - JACKSON SENIOR LIVING LLC Type: CBRF HCBS COMPLIANT (847) 612-0750 Class: CNA W194 N16744 EAGLE DRIVE ADVANCED AGED JACKSON WI 53037 DEAN MASCHOFF Gender - Capacity: M/F - 22 (262) 677-0651 HEIDI GEHRKE PO BOX 47199 Low/High rate: 4,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON CHICAGO IL 60647 Initial License: 02/15/2019 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 142 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

GATEWOOD CBRF (0014745) BRIDGES OF WISCONSIN INC Type: CBRF HCBS COMPLIANT (262) 338-4941 Class: CNA 1430 GATEWOOD DR ADVANCED AGED WEST BEND WI 53095 KATHY MCCARDELL Gender - Capacity: M/F - 6 (262) 338-4941 KATHLEEN MCCARDELL 1625 E WASHINGTON ST STE 111 Low/High rate: 5,323/6,734 DEVELOPMENTALLY DISABLED County: WASHINGTON WEST BEND WI 53095 Initial License: 10/07/2013 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY Association Approval: WALA GERMANTOWN HOME (0012454) GUARANTEED QUALITY LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 365-3606 Class: CNA W164 N10502 TIMBERLINE CT DEVELOPMENTALLY DISABLED GERMANTOWN WI 53022 ROBIN MCCAIGUE Gender - Capacity: M/F - 7 (262) 365-3606 ROBIN MCCAIGUE 2030 E WASHINGTON ST Low/High rate: 4,305/5,007 EMOTIONALLY DISTURBED/MENTAL County: WASHINGTON WEST BEND WI 53095 Initial License: 08/18/2008 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY HARTFORD ESTATES I (0017805) HARTFORD ESTATES ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (414) 915-0710 Class: CNA 109 LONE OAK LN ADVANCED AGED HARTFORD WI 53027 EMMY MYERS Gender - Capacity: M/F - 8 (414) 915-0710 EMMY MYERS 839 N JEFFERSON ST STE 502 Low/High rate: 3,200/5,000 ALCOHOL/DRUG DEPENDENT County: WASHINGTON MILWAUKEE WI 53202 Initial License: 10/30/2019 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY HAWTHORN MANOR INC (310413) ANITA BECKER Type: CBRF HCBS COMPLIANT (262) 338-3266 Class: AS 321 HAWTHORN DR ADVANCED AGED WEST BEND WI 53095 ANITA BECKER Gender - Capacity: M/F - 13 (262) 338-3266 ANITA BECKER 5743 DEBBIE LANE Low/High rate: 2,000/3,400 EMOTIONALLY DISTURBED/MENTAL County: WASHINGTON WEST BEND WI 53095 Initial License: 06/28/1989 IRREVERSIBLE DEMENTIA/ALZHEIM HIL COLUMBUS HOUSE (0013271) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 446-4488 Class: AA 5096 VALLEY TRL DEVELOPMENTALLY DISABLED WEST BEND WI 53095 ASHLEY WILLIAMS Gender - Capacity: M/F - 5 (262) 338-3937 JESSICA COLE 1249 RUSSETT COURT Low/High rate: 5,187/5,187 EMOTIONALLY DISTURBED/MENTAL County: WASHINGTON GREEN BAY WI 54313 Initial License: 07/12/2010 PUBLIC FUNDING TRAUMATIC BRAIN INJURY IVY MANOR OF WEST BEND (0013787) IVY MANOR OF WEST BEND LLC Type: CBRF HCBS COMPLIANT (262) 305-1209 Class: CNA 370 S FOREST AVE ADVANCED AGED WEST BEND WI 53095 SUSAN K POLSTER Gender - Capacity: M/F - 26 (262) 305-1209 SUSAN K POLSTER 370 S FOREST AVE Low/High rate: 4,150/5,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53095 Initial License: 09/15/2011 PHYSICALLY DISABLED TERMINALLY ILL IVY MANOR OF WEST BEND BLDG 2 (0014319) IVY MANOR OF WEST BEND LLC Type: CBRF HCBS COMPLIANT (262) 305-1209 Class: CNA 350 S FOREST ADVANCED AGED WEST BEND WI 53095 SUSAN POLSTER Gender - Capacity: M/F - 26 (262) 365-0056 SUSAN K POLSTER 129 ERIN CT Low/High rate: 4,150/5,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53095 Initial License: 09/24/2012 PHYSICALLY DISABLED TERMINALLY ILL IVY MANOR OF WEST BEND BUILDING 3 (0015803) IVY MANOR OF WEST BEND LLC Type: CBRF HCBS COMPLIANT (262) 305-1209 Class: CNA 365 S FOREST AVE ADVANCED AGED WEST BEND WI 53095 SUSAN POLSTER Gender - Capacity: M/F - 22 (262) 365-0056 SUSAN POLSTER 370 S FOREST AVE Low/High rate: 4,500/5,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53095 Initial License: 10/01/2015 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 143 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

KETTLE MORAINE GARDENS (0012055) TINA THULL Type: CBRF HCBS COMPLIANT (262) 689-9725 Class: CNA 1038 FOND DU LAC AVE ADVANCED AGED KEWASKUM WI 53040 TINA THULL Gender - Capacity: M/F - 21 (262) 626-4990 ANGELA THULL 8735 HWY HH Low/High rate: 3,595/5,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON KEWASKUM WI 53040 Initial License: 11/15/2007 PHYSICALLY DISABLED TERMINALLY ILL KETTLE MORAINE GARDENS MEMORY UNIT (0012054) TINA THULL Type: CBRF HCBS COMPLIANT (262) 689-9725 Class: CNA 1042 FOND DU LAC AVE IRREVERSIBLE DEMENTIA/ALZHEIM KEWASKUM WI 53040 TINA THULL Gender - Capacity: M/F - 15 (262) 626-2775 TOM THULL 8735 HWY HH Low/High rate: 4,800/6,900 County: WASHINGTON KEWASKUM WI 53040 Initial License: 11/15/2007 LANDMARK AT JACKSON CROSSINGS (THE) (0015325) SNH SE TENANT TRS INC Type: CBRF HCBS COMPLIANT (617) 796-8350 Class: CNA N168 W22022 MAIN ST ADVANCED AGED JACKSON WI 53037 LISA NEWCOMB Gender - Capacity: M/F - 24 (262) 993-2838 GAIL GORDON 400 CENTRE ST Low/High rate: 5,105/7,337 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON NEWTON MA 02458 Initial License: 12/01/2014 PUBLIC FUNDING MAJESTIC HEIGHTS ASSISTED LIVING (0015124) SEDONIA LLC Type: CBRF HCBS COMPLIANT (414) 315-9889 Class: CNA 85 S WACKER DR ADVANCED AGED HARTFORD WI 53027 MARGARET PRITZLAFF Gender - Capacity: M/F - 26 (262) 670-6499 MARGARET PRITZLAFF 85 S WACKER DR Low/High rate: 4,000/5,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON HARTFORD WI 53027 Initial License: 06/30/2014 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL MAJESTIC HEIGHTS ASSISTED LIVING II (0016367) SEDONIA LLC Type: CBRF HCBS COMPLIANT (414) 315-9889 Class: CNA 63 SOUTH WACKER DRIVE ADVANCED AGED HARTFORD WI 53027 MARGARET PRITZLAFF Gender - Capacity: M/F - 26 (262) 670-8661 MARGARET PRITZLAFF 85 S WACKER DRIVE Low/High rate: 4,000/5,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON HARTFORD WI 53027 Initial License: 11/22/2016 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL MATTERHAUS (0017235) CHIARA COMMUNITIES INC Type: CBRF HCBS COMPLIANT (262) 798-1224 Class: CNA N109 W17000 AVA CIR ADVANCED AGED GERMANTOWN WI 53022 GLEN CHOBAN Gender - Capacity: M/F - 26 (262) 345-6899 ELIZABETH RUNDLE 20875 CROSSROADS CIR STE 400 Low/High rate: 6,145/8,190 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WAUKESHA WI 53186 Initial License: 11/01/2018 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL NEW PERSPECTIVE-WEST BEND (0013625) WEST BEND OPS LLC Type: CBRF HCBS COMPLIANT (218) 721-2800 Class: CNA 2130 CONTINENTAL DR ADVANCED AGED WEST BEND WI 53095 JENNA RITACCA Gender - Capacity: M/F - 60 (262) 338-0092 JENNA RITACCA 2130 CONTINENTAL DR Low/High rate: 4,000/6,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53095 Initial License: 10/20/2011 PUBLIC FUNDING NEW PERSPECTIVE-WEST BEND (0013625) WEST BEND OPS LLC Type: CBRF HCBS COMPLIANT (218) 721-2800 Class: CNA 2130 CONTINENTAL DR ADVANCED AGED WEST BEND WI 53095 JENNA RITACCA Gender - Capacity: M/F - 60 (262) 338-0092 JENNA RITACCA 2130 CONTINENTAL DR Low/High rate: 4,000/6,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53095 Initial License: 10/20/2011 PUBLIC FUNDING NEW PERSPECTIVE-WEST BEND (0013625) WEST BEND OPS LLC Type: CBRF HCBS COMPLIANT (218) 721-2800 Class: CNA 2130 CONTINENTAL DR ADVANCED AGED WEST BEND WI 53095 JENNA RITACCA Gender - Capacity: M/F - 60 (262) 338-0092 JENNA RITACCA 2130 CONTINENTAL DR Low/High rate: 4,000/6,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53095 Initial License: 10/20/2011 PUBLIC FUNDING NEW PERSPECTIVE-WEST BEND (0013625) WEST BEND OPS LLC Type: CBRF HCBS COMPLIANT (218) 721-2800 Class: CNA 2130 CONTINENTAL DR ADVANCED AGED WEST BEND WI 53095 JENNA RITACCA Gender - Capacity: M/F - 60 (262) 338-0092 JENNA RITACCA 2130 CONTINENTAL DR Low/High rate: 4,000/6,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON WEST BEND WI 53095 Initial License: 10/20/2011 PUBLIC FUNDING Association Approval: WALA

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 144 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SERENITY VILLA (0012822) TRACY ERMER Type: CBRF HCBS COMPLIANT (262) 689-6973 Class: CNA 1650 AMERICAN EAGLE DR ADVANCED AGED SLINGER WI 53086 TRACY ERMER Gender - Capacity: M/F - 25 (262) 297-1512 TRACY ERMER 7860 HIGHLAND DR Low/High rate: 5,000/6,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON KEWASKUM WI 53040 Initial License: 06/15/2009 PHYSICALLY DISABLED TERMINALLY ILL SERENITY VILLA ASSISTED LIVING (0015363) EVELEE LLC Type: CBRF HCBS COMPLIANT (262) 644-9204 Class: CNA 1707 AMERICAN EAGLE DR ADVANCED AGED SLINGER WI 53086 TRACY ERMER Gender - Capacity: M/F - 26 (262) 644-9204 TRACY ERMER 7860 HIGHLAND DRIVE Low/High rate: 5,000/6,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON KEWASKUM WI 53040 Initial License: 12/18/2014 PHYSICALLY DISABLED TERMINALLY ILL SERENITY VILLA ASSISTED LIVING IV (0016309) EVELEE LLC Type: CBRF HCBS COMPLIANT (262) 689-6973 Class: CNA 1727 AMERICAN EAGLE DR ADVANCED AGED SLINGER WI 53086 TRACY ERMER Gender - Capacity: M/F - 26 (262) 644-0720 TRACY ERMER 7860 HIGHLAND DR Low/High rate: 5,000/6,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON KEWASKUM WI 53086 Initial License: 09/26/2016 SERENITY VILLA II (0013482) TRACY L ERMER Type: CBRF HCBS COMPLIANT (262) 689-6973 Class: CNA 1600 AMERICAN EAGLE DR IRREVERSIBLE DEMENTIA/ALZHEIM SLINGER WI 53086 TRACY L ERMER Gender - Capacity: M/F - 26 (262) 644-9204 TRACY L ERMER 7860 HIGHLAND DR Low/High rate: 5,400/6,000 PHYSICALLY DISABLED County: WASHINGTON KEWASKUM WI 53086 Initial License: 11/16/2010 TERMINALLY ILL WATERFORD AT HARTFORD (THE) (0015651) CSL HARTFORD LLC Type: CBRF HCBS COMPLIANT (972) 308-8387 Class: CNA 1025 BELL AVE ADVANCED AGED HARTFORD WI 53027 KIRSTEN HUTCHISON Gender - Capacity: M/F - 19 (262) 670-9477 KIRSTEN HUTCHISON 1025 BELL AVE Low/High rate: 3,500/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON HARTFORD WI 53027 Initial License: 05/21/2015 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL WATERFORD AT WEST BEND (THE) (0015650) CSL WEST BEND LLC Type: CBRF HCBS COMPLIANT (972) 308-8387 Class: CNA 831 E WASHINGTON ADVANCED AGED WEST BEND WI 53095 KIRSTEN HUTCHISON Gender - Capacity: M/F - 48 (262) 335-1992 KIRSTEN HUTCHISON 1740 CONDOR LANE Low/High rate: 3,200/5,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON GREEN BAY WI 54313 Initial License: 05/21/2015 PHYSICALLY DISABLED TERMINALLY ILL WELLINGTON PLACE AT HARTFORD (0017434) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (303) 980-0611 Class: CNA 615 HILLDALE DRIVE ADVANCED AGED HARTFORD WI 53027 MONICA RAKOWSKI Gender - Capacity: M/F - 30 (262) 673-3544 MONICA RAKOWSKI 615 HILLDALE DRIVE Low/High rate: 2,900/5,150 IRREVERSIBLE DEMENTIA/ALZHEIM County: WASHINGTON HARTFORD WI 53027 Initial License: 03/05/2020 PHYSICALLY DISABLED ADULT EATING DISORDER RESIDENTIAL CARE (0017711) ROGERS MEMORIAL HOSPITAL Type: CBRF EMOTIONALLY DISTURBED/MENTAL W277 OAKWOOD DR (262) 646-4411 Class: AA DELAFIELD WI 53018 Maeve O'Neil Gender - Capacity: M/F - 8 (262) 646-4411 KIMBERLY EFFERTZ 34700 VALLEY RD Low/High rate: 28,560/28,560 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 06/26/2019 ADULT MENTAL HEALTH RESIDENTIAL CARE (0017617) ROGERS MEMORIAL HOSPITAL Type: CBRF EMOTIONALLY DISTURBED/MENTAL 34700 VALLEY RD (262) 646-4411 Class: AA OCONOMOWOC WI 53066 Maeve O'Neil Gender - Capacity: M/F - 12 (262) 646-4411 KIMBERLY EFFERTZ 34700 VALLEY RD Low/High rate: 28,560/28,560 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 07/03/2019 ADULT RESIDENTIAL CARE (0017618) ROGERS MEMORIAL HOSPITAL Type: CBRF EMOTIONALLY DISTURBED/MENTAL 34700 VALLEY RD (262) 646-4411 Class: AA OCONOMOWOC WI 53066 Maeve O'Neil Gender - Capacity: M/F - 24 (262) 646-4411 KIMBERLY EFFERTZ 34700 VALLEY RD Low/High rate: 28,560/28,560 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 06/26/2019 ANDREW HOME (0009790) PRADER WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AA 909 OLD TOWER RD DEVELOPMENTALLY DISABLED OCONOMOWOC WI 53066 Vicky Raml-Glider Gender - Capacity: F - 8 (262) 468-0366 Sarah Goralski PO BOX 278 Low/High rate: 9,784/9,784 County: WAUKESHA DOUSMAN WI 53118 Initial License: 10/07/2002

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 145 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ANTHONY HOME (0009786) PRADER WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-4848 Class: AA 1231 BLUE DAHLIA RD DEVELOPMENTALLY DISABLED OCONOMOWOC WI 53066 Vicky Raml-Glider Gender - Capacity: M/F - 8 (262) 569-5501 Kristina Lumby PO BOX 278 Low/High rate: 10,007/10,007 County: WAUKESHA DOUSMAN WI 53118 Initial License: 01/01/2002 ARBOR VIEW COMMUNITIES OF PEWAUKEE (0017089) PARKSIDE OF ARBOR VIEW LLC Type: CBRF HCBS COMPLIANT (847) 779-8501 Class: CNA W232 N3471 HUNTERS RIDGE RD IRREVERSIBLE DEMENTIA/ALZHEIM PEWAUKEE WI 53072 BRITNEE REINDERS Gender - Capacity: M/F - 31 (262) 691-7400 Nicole Turluck W232N3471 HUNTERS RIDGE RD Low/High rate: 4,200/6,200 PHYSICALLY DISABLED County: WAUKESHA PEWAUKEE WI 53072 Initial License: 04/16/2018 TERMINALLY ILL ARBORETUM V LLC (THE) CBRF (310670) ARBORETUM V LLC (THE) Type: CBRF HCBS COMPLIANT (262) 548-5965 Class: CNA W180 N7890 TOWN HALL RD ADVANCED AGED MENOMONEE FALLS WI 53051 BETH ANDERSON Gender - Capacity: M/F - 78 (262) 253-0909 MARIE D'AMICO 1805 KENSINGTON DR Low/High rate: 5,000/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA WAUKESHA WI 53188 Initial License: 10/01/1990 PUBLIC FUNDING WAIVER CERTIFIED INDEPENDENT C ASPEN CENTER (0018227) LSS OF WI AND UPPER MI INC Type: CBRF HCBS COMPLIANT (414) 246-2711 Class: AA 2000 WEST BLUEMOUND ROAD ALCOHOL/DRUG DEPENDENT WAUKESHA WI 53186 PAULA UPP Gender - Capacity: M/F - 22 (414) 246-2730 CONNIE SCHRANK 3003 NORTH RICHMOND STREET Low/High rate: 4,800/30,000 County: WAUKESHA APPLETON WI 54911 Initial License: 09/10/2020 AUBERGE AT BROOKFIELD A MEMORY CARE COMM (TH WELLTOWER TENANT GROUP LLC Type: CBRF HCBS COMPLIANT (419) 247-2800 Class: CNA 1105 DAVIDSON RD ADVANCED AGED BROOKFIELD WI 53045 MATTHEW DUNHAM Gender - Capacity: M/F - 95 (262) 641-9020 Elizabeth SNYDER 7420 BRIDGEPORT RD STE 105 Low/High rate: 7,395/11,995 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA PORTLAND OR 97224 Initial License: 08/11/2020 AUBERGE AT OAK VILLAGE A MEMORY CARE COMM (TH WELLTOWER TENANT GROUP LLC Type: CBRF HCBS COMPLIANT (419) 247-2800 Class: CNA W128 N6900 NORTHFIELD DR ADVANCED AGED MENOMONEE FALLS WI 53051 MATTHEW DUNHAM Gender - Capacity: M/F - 56 (262) 532-0800 Sabbatini Samantha 7420 BRIDGEPORT RD STE 105 Low/High rate: 7,490/11,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA PORTLAND WA 97224 Initial License: 11/13/2019 AUSTIN HALL (0009717) OCONOMOWOC DEV TRNG CTR OF WIS LLC Type: CBRF DEVELOPMENTALLY DISABLED 36100 GENESEE LAKE RD (262) 567-5510 Class: AA OCONOMOWOC WI 53066 KIM RAY Gender - Capacity: M/F - 6 (262) 569-5514 Vicky Raml-Glider 36100 GENESEE LAKE RD Low/High rate: 14,288/14,288 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 01/01/2002 AUTUMN BAY OF PEWAUKEE (0014550) AUTUMN BAY LLC Type: CBRF HCBS COMPLIANT (414) 840-3981 Class: CNA 539 E WISCONSIN ADVANCED AGED PEWAUKEE WI 53072 LORI PAPROCKI Gender - Capacity: M/F - 22 (262) 691-9622 LORI PAPROCKI 539 E WISCONSIN Low/High rate: 5,700/6,700 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA PEWAUKEE WI 53072 Initial License: 06/11/2013 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY AUTUMN LEAF ASSISTED LIVING LLC (0018278) AUTUMN LEAF ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (262) 788-9974 Class: ANA 12850 WEST EUCLID AVENUE ADVANCED AGED NEW BERLIN WI 53151 LAUREN BALTZ Gender - Capacity: M/F - 10 (262) 788-9974 LAUREN BALTZ 1474 SOUTH 97TH STREET Low/High rate: 3,950/4,950 DEVELOPMENTALLY DISABLED County: WAUKESHA WEST ALLIS WI 53214 Initial License: 02/24/2021 PHYSICALLY DISABLED AVALON SQUARE INC (0009325) AVALON SQUARE INC Type: CBRF HCBS COMPLIANT (262) 547-6741 Class: CNA 222 PARK PLACE ADVANCED AGED WAUKESHA WI 53186 Lisa Fleckenstein Gender - Capacity: M/F - 27 (262) 547-6741 LISA FLECKENSTEIN 222 PARK PLACE Low/High rate: 4,555/7,860 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA WAUKESHA WI 53186 Initial License: 12/14/2001 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin AZURA AT MIEROW FARM BROOKFIELD BUILDING B (001 AZURA BROOKFIELD LLC Type: CBRF HCBS COMPLIANT (303) 909-4081 Class: CNA 16030 WASHINGTON DRIVE ADVANCED AGED BROOKFIELD WI 53005 JILL KREIDER Gender - Capacity: M/F - 24 (262) 606-1555 Michael Stemm 1233 NORTH MAYFAIR ROAD 301 Low/High rate: 4,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA MILWAUKEE WI 53226 Initial License: 10/14/2020 TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 146 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

AZURA AT MIEROW FARM BROOKFIELD BUILDING C (001 AZURA BROOKFIELD Type: CBRF HCBS COMPLIANT (303) 909-4081 Class: CNA 16020 WASHINGTON DRIVE ADVANCED AGED BROOKFIELD WI 53005 JILL KREIDER Gender - Capacity: M/F - 30 (262) 227-0075 Michael Stemm 1233 NORTH MAYFAIR ROAD 301 Low/High rate: 4,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA MILWAUKEE WI 53226 Initial License: 11/09/2020 TERMINALLY ILL AZURA AT MIEROW FARM BROOKFIELD BUILDING D (001 AZURA BROOKFIELD LLC Type: CBRF HCBS COMPLIANT (303) 909-4081 Class: CNA 16010 WASHINGTON DRIVE ADVANCED AGED BROOKFIELD WI 53005 JILL KREIDER Gender - Capacity: M/F - 30 (262) 227-0075 Michael Stemm 1233 NORTH MAYFAIR ROAD 301 Low/High rate: 4,000/10,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA MILWAUKEE WI 53226 Initial License: 01/08/2021 TERMINALLY ILL AZURA MEMORY CARE OF OCONOMOWOC (0016080) AZURA OCONOMOWOC LLC Type: CBRF ADVANCED AGED (303) 909-4081 Class: CNA 540 E FOREST ST IRREVERSIBLE DEMENTIA/ALZHEIM OCONOMOWOC WI 53066 JILL KREIDER Gender - Capacity: M/F - 44 (262) 567-4101 Amanda Montello 1233 MAYFAIR RD STE 301 Low/High rate: 5,800/8,200 County: WAUKESHA WAUWATOSA WI 53226 Initial License: 06/01/2016 BETHANY CHRISTIAN SERVICES (0018427) BETHANY CHRISTIAN SERVICES Type: CBRF ALCOHOL/DRUG DEPENDENT (262) 547-6557 Class: AA 1331 CAPITOL DRIVE CORRECTIONAL CLIENTS OCONOMOWOC WI 53066 DEBRA ADAMUS Gender - Capacity: F - 30 (262) 547-6557 JENNIFER SCHMEICHEL 1331 CAPITOL DRIVE Low/High rate: 10,740/11,340 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 06/02/2021 PREGNANT WOMEN/COUNSELLING BIRCHROCK CASTLE (0017104) CASTLE SENIOR LIVING INC Type: CBRF ADVANCED AGED (414) 427-1655 Class: CNA 210 MCDIVITT LN IRREVERSIBLE DEMENTIA/ALZHEIM MUKWONAGO WI 53149 Candy Mings Gender - Capacity: M/F - 20 (262) 363-9998 Candy Mings 13050 W Cleveland AVE Low/High rate: 3,200/6,500 PHYSICALLY DISABLED County: WAUKESHA New Berlin WI 53149-5315 Initial License: 03/30/2018 TERMINALLY ILL Association Approval: WALA BONNIE LANE (0018184) PRADER-WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-4848 Class: AA 18535 BONNIE LANE DEVELOPMENTALLY DISABLED BROOKFIELD WI 53045 Vicki Raml-Glider Gender - Capacity: M/F - 8 (262) 649-3301 KRISTINA LUMBY PO BOX 278 Low/High rate: 8,500/12,000 County: WAUKESHA DOUSMAN WI 53118 Initial License: 07/14/2020 BRADFORD HOME (0012560) PRADER-WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-4848 Class: AA 644 BRADFORD WAY DEVELOPMENTALLY DISABLED HARTLAND WI 53029 Vicki Raml-Glider Gender - Capacity: F - 8 (262) 361-4670 MARGUERITE Rupnow PO BOX 278 Low/High rate: 7,760/7,760 County: WAUKESHA DOUSMAN WI 53118 Initial License: 12/03/2008 BROLEN MEADOWS (0016907) MI VIDA BONITA LLC Type: CBRF ADVANCED AGED (262) 873-0034 Class: CNA 1340 MAIN ST EMOTIONALLY DISTURBED/MENTAL MUKWONAGO WI 53149 MARY READ Gender - Capacity: M/F - 20 (262) 873-0034 MARY READ 1698 AQUA VIEW DR Low/High rate: 4,000/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA CEDARBURG WI 53012 Initial License: 08/20/2018 PHYSICALLY DISABLED TERMINALLY ILL BROOKDALE BROOKFIELD AL (0013589) BKD BROOKDALE PLACE OF BROOKFIELD, LLC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 660 WOELFEL RD ADVANCED AGED BROOKFIELD WI 53045 BRANDON VAN VORS Gender - Capacity: M/F - 95 (262) 789-7499 BRANDON VAN VORS 660 WOELFEL RD Low/High rate: 3,745/5,695 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA BROOKFIELD WI 53045 Initial License: 02/25/2011 PHYSICALLY DISABLED PUBLIC FUNDING BROOKDALE BROOKFIELD CAPITOL DRIVE (310345) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 15100 W CAPITOL DR ADVANCED AGED BROOKFIELD WI 53005 Gregory Young Gender - Capacity: M/F - 24 (262) 781-5220 GREGORY YOUNG 15100 W CAPITOL DR Low/High rate: 5,295/5,295 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA BROOKFIELD WI 53005 Initial License: 10/30/1991 PUBLIC FUNDING BROOKDALE BROOKFIELD MC (0014569) BKD CLARE BRIDGE PLACE BROOKFIELD LLC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA 685 WOELFEL RD ADVANCED AGED BROOKFIELD WI 53045 DIANA GAST Gender - Capacity: M/F - 20 (262) 754-2761 BRANDON VAN VORS 685 WOELFEL RD Low/High rate: 5,395/5,795 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA BROOKFIELD WI 53045 Initial License: 05/23/2013 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 147 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BROOKDALE SUSSEX (310682) BROOKDALE SENIOR LIVING COMMUNITIES INC Type: CBRF HCBS COMPLIANT (414) 918-5000 Class: CNA W240 N6351 MAPLE AVE ADVANCED AGED SUSSEX WI 53089 Robin Frievalt Gender - Capacity: M/F - 20 (262) 820-0330 ROBIN FRIEVALT W240 N6351 MAPLE AVE Low/High rate: 2,595/2,995 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA SUSSEX WI 53089 Initial License: 11/10/1997 PUBLIC FUNDING BUTLER HOUSE (0017522) BUTLER HOUSE LLC Type: CBRF HCBS COMPLIANT () - Class: CNA 12605 W COURTLAND AVE ADVANCED AGED BUTLER WI 53007 MICHAEL ROGINSKIY Gender - Capacity: M/F - 8 (888) 484-5045 MICHAEL ROGINSKIY PO BOX 242444 Low/High rate: 4,000/7,000 ALCOHOL/DRUG DEPENDENT County: WAUKESHA MILWAUKEE WI 53224 Initial License: 01/13/2020 CORRECTIONAL CLIENTS DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CARING ALTERNATIVES OF MUSKEGO (0017155) CARING ALTERNATIVES LLC Type: CBRF HCBS COMPLIANT (414) 305-9533 Class: CNA W182 S8320 PIONEER DR ADVANCED AGED MUSKEGO WI 53150 WENDY SIEVERT Gender - Capacity: M/F - 34 (414) 305-9533 WENDY SIEVERT PO BOX 308 Low/High rate: 5,450/6,250 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA OAK CREEK WI 53154 Initial License: 09/24/2018 CASEY HOUSE (0010138) OCONOMOWOC DEV TRNG CTR OF WIS LLC Type: CBRF DEVELOPMENTALLY DISABLED (262) 569-5515 Class: AA 36100 GENESEE LAKE RD PUBLIC FUNDING OCONOMOWOC WI 53066 KIM RAY Gender - Capacity: M/F - 8 (262) 569-5532 SARAH GORALSKI 36100 GENESEE LAKE RD Low/High rate: 14,828/14,828 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 02/09/2004 CCLS MADERA ST (0016026) CREATIVE COMMUNITY LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: CNA 1920 MADERA ST DEVELOPMENTALLY DISABLED WAUKESHA WI 53189 JIM ZACHE Gender - Capacity: M/F - 8 (262) 549-9491 Rick Czerwan 314 E MAIN ST Low/High rate: 3,923/4,661 PHYSICALLY DISABLED County: WAUKESHA WATERTOWN WI 53094 Initial License: 06/16/2016 PUBLIC FUNDING Association Approval: DSPN CCLS OAKDALE DRIVE (310328) CREATIVE COMMUNITY LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AA 1606 OAKDALE DR DEVELOPMENTALLY DISABLED WAUKESHA WI 53186 JIM ZACHE Gender - Capacity: M/F - 8 (920) 261-1345 Jim Zache 314 E MAIN ST Low/High rate: 1,899/3,509 PUBLIC FUNDING County: WAUKESHA WATERTOWN WI 53094 Initial License: 06/28/1991 Association Approval: DSPN CCLS VICTORIA DRIVE (0009420) CREATIVE COMMUNITY LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AA 1425 VICTORIA DR DEVELOPMENTALLY DISABLED WAUKESHA WI 53186 Jim Zache Gender - Capacity: M/F - 8 (262) 955-3554 Rick Czerwan 314 E Main Street Low/High rate: 1,749/3,509 PUBLIC FUNDING County: WAUKESHA Watertown WI 53094 Initial License: 09/25/2001 Association Approval: DSPN CCLS WELSH COURT (310329) CREATIVE COMMUNITY LIVING SERVICES INC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AA 2704 2706 WELSH CT DEVELOPMENTALLY DISABLED WAUKESHA WI 53188 JIM ZACHE Gender - Capacity: M/F - 8 (262) 547-6267 JIM ZACHE 314 E MAIN ST Low/High rate: 3,160/3,160 PUBLIC FUNDING County: WAUKESHA WATERTOWN WI 53094 Initial License: 08/01/1984 CEPHAS HALFWAY HOUSE (0013468) LUTHERAN SOCIAL SERVICES OF WI AND UPPE Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 246-2300 Class: AA 325 SENTINEL DRIVE CORRECTIONAL CLIENTS WAUKESHA WI 53189 PAULA UPP Gender - Capacity: M - 14 (262) 549-9449 CONNIE SCHRANK 3003 N. Richmond St. Low/High rate: 38,808/42,966 County: WAUKESHA Appleton WI 54911 Initial License: 02/07/2011 CORY HOME (0012200) OCONOMOWOC DEVELOPMENTAL TRAINING CE Type: CBRF HCBS COMPLIANT (262) 569-5510 Class: AA 201/203 CORY AVE DEVELOPMENTALLY DISABLED DOUSMAN WI 53118 Vicky Raml-Glider Gender - Capacity: M/F - 8 (262) 965-2050 Sara Goralski 36100 GENESEE LAKE RD Low/High rate: 14,288/14,288 PUBLIC FUNDING County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 11/27/2007

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 148 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CREATIVE LIVING ENVIRONMENTS CLARION MANOR (00 CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 21325 CLARION LN ADVANCED AGED WAUKESHA WI 53186 JIM ZACHE Gender - Capacity: M/F - 8 (262) 798-1825 TENISHA LOVE 314 E MAIN ST Low/High rate: 2,937/3,500 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA WATERTOWN WI 53094 Initial License: 10/01/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CREATIVE LIVING ENVIRONMENTS CLARION MANOR (00 CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 21325 CLARION LN ADVANCED AGED WAUKESHA WI 53186 JIM ZACHE Gender - Capacity: M/F - 8 (262) 798-1825 TENISHA LOVE 314 E MAIN ST Low/High rate: 2,937/3,500 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA WATERTOWN WI 53094 Initial License: 10/01/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CREATIVE LIVING ENVIRONMENTS CLARION MANOR (00 CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 21325 CLARION LN ADVANCED AGED WAUKESHA WI 53186 JIM ZACHE Gender - Capacity: M/F - 8 (262) 798-1825 TENISHA LOVE 314 E MAIN ST Low/High rate: 2,937/3,500 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA WATERTOWN WI 53094 Initial License: 10/01/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: DSPN CREATIVE LIVING ENVIRONMENTS RAINBOW TERRACE CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 15831 W SANTA ROSA BLVD ADVANCED AGED NEW BERLIN WI 53151 JIM ZACHE Gender - Capacity: M/F - 8 (262) 782-5777 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,010/3,417 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA WATERTOWN WI 53094 Initial License: 10/01/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CREATIVE LIVING ENVIRONMENTS RAINBOW TERRACE CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 15831 W SANTA ROSA BLVD ADVANCED AGED NEW BERLIN WI 53151 JIM ZACHE Gender - Capacity: M/F - 8 (262) 782-5777 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,010/3,417 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA WATERTOWN WI 53094 Initial License: 10/01/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING CREATIVE LIVING ENVIRONMENTS RAINBOW TERRACE CREATIVE LIVING ENVIRONMENTS LLC Type: CBRF HCBS COMPLIANT (920) 261-1345 Class: AS 15831 W SANTA ROSA BLVD ADVANCED AGED NEW BERLIN WI 53151 JIM ZACHE Gender - Capacity: M/F - 8 (262) 782-5777 TENISHA LOVE 314 E MAIN ST Low/High rate: 3,010/3,417 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA WATERTOWN WI 53094 Initial License: 10/01/2008 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING Association Approval: DSPN CURTIS HALL (0009718) OCONOMOWOC DEV TRNG CTR OF WIS LLC Type: CBRF HCBS COMPLIANT (262) 569-5510 Class: AA 36100 GENESEE LAKE RD DEVELOPMENTALLY DISABLED OCONOMOWOC WI 53066 KIM RAY Gender - Capacity: M/F - 7 (262) 569-5536 Vicky Raml-Glider 36100 GENESEE LAKE RD Low/High rate: 14,288/14,288 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 01/01/2002 DICKSON HOLLOW (0016047) PHW MENOMONEE FALLS INC Type: CBRF ADVANCED AGED (262) 599-8300 Class: CNA W156 N4881 PILGRIM RD IRREVERSIBLE DEMENTIA/ALZHEIM MENOMONEE FALLS WI 53051 KARI AJACK Gender - Capacity: M/F - 19 (262) 599-8300 Jenny Weise W156 N4881 PILGRIM RD Low/High rate: 4,950/7,700 County: WAUKESHA MENOMONEE FALLS WI 53051 Initial License: 04/28/2016 Association Approval: LeadingAge Wisconsin DILANA HOUSE (0012234) MILOUDI INC Type: CBRF ADVANCED AGED (262) 271-0993 Class: CS W274 S4025 TIMBER TRL DEVELOPMENTALLY DISABLED WAUKESHA WI 53189 SAM LAHRACHE Gender - Capacity: M - 8 (262) 408-2102 Sam Lahrache W274 S4025 TIMBER TRL Low/High rate: 3,200/3,500 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA WAUKESHA WI 53189 Initial License: 01/23/2008 IRREVERSIBLE DEMENTIA/ALZHEIM

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 149 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ELIZABETH RESIDENCE NEW BERLIN (0016570) RICHJON LLC Type: CBRF HCBS COMPLIANT (414) 687-0558 Class: CNA 4461 S SUNNY SLOPE RD ADVANCED AGED NEW BERLIN WI 53151 RICHARD COURY Gender - Capacity: M/F - 30 (414) 858-4300 RICHARD COURY 4461 S SUNNY SLOPE RD Low/High rate: 5,700/8,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA NEW BERLIN WI 53151 Initial License: 05/01/2017 Association Approval: WALA EVIN AT OCONOMOWOC SPECIALTY CARE (0018399) KORU HEALTH LLC Type: CBRF ADVANCED AGED (414) 507-6928 Class: CNA 1101 SILVER LAKE ST IRREVERSIBLE DEMENTIA/ALZHEIM OCONOMOWOC WI 53066 ANDY LANGE Gender - Capacity: M/F - 22 (262) 320-3846 CHRIS MATUSENIC 6650 W STATE ST 112 Low/High rate: 4,200/7,000 PHYSICALLY DISABLED County: WAUKESHA WAUWATOSA WI 53213 Initial License: 02/01/2021 TERMINALLY ILL GATE HOUSE (0009716) PRADER WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-4848 Class: AA 123 LAWN ST DEVELOPMENTALLY DISABLED HARTLAND WI 53029 Vicki Raml-Glider Gender - Capacity: M/F - 16 (262) 367-0644 Kristina Lumby PO BOX 278 Low/High rate: 9,856/9,856 County: WAUKESHA DOUSMAN WI 53118 Initial License: 01/01/2002 GRACE COMMONS II (0018200) CAPRI COMMUNITIES LLC Type: CBRF HCBS COMPLIANT (262) 798-1224 Class: CNA W195N9550 ROLLING MEADOWS CIRC ADVANCED AGED MENOMONEE FALLS WI 53051 GLEN CHOBAN Gender - Capacity: M/F - 24 (262) 252-9600 MEGAN KIRCHNER 20875 CROSSROADS CIRCLE SUITE Low/High rate: 5,400/7,875 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA WAUKESHA WI 53186 Initial License: 08/06/2020 PHYSICALLY DISABLED TERMINALLY ILL GRAND HILLS CASTLE (THE) (0017249) CASTLE SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (414) 427-1655 Class: CNA 13050 W CLEVELAND AVE ADVANCED AGED NEW BERLIN WI 53151 KRISTOPHER KIEFER Gender - Capacity: M/F - 48 (262) 347-4479 Elizabeth Kirsch 13050 W Cleveland ave Low/High rate: 4,000/8,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA New Berlin WI 53151 Initial License: 08/30/2018 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA HANSON HOUSE (0009739) PRADER WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CS 240 WOLF DRIVE DEVELOPMENTALLY DISABLED DOUSMAN WI 53118 Vicki Raml-Glider Gender - Capacity: M/F - 14 (262) 965-2162 Kristina Lumby P O BOX 278 Low/High rate: 11,318/11,318 County: WAUKESHA DOUSMAN WI 53118 Initial License: 10/24/2002 HARTFEL HOUSE (310410) STEP INC Type: CBRF HCBS COMPLIANT (262) 251-1265 Class: AA N88 W17630 CHRISTMAN RD DEVELOPMENTALLY DISABLED MENOMONEE FALLS WI 53051 BARBARA PRICE Gender - Capacity: M - 8 (262) 251-1265 BARBARA PRICE N88 W17630 CHRISTMAN RD Low/High rate: 2,070/3,074 PUBLIC FUNDING County: WAUKESHA MENOMONEE FALLS WI 53051 Initial License: 05/01/1980 HARTLAND PLACE (0015977) HERITAGE HOUSE OF HARTLAND LLC Type: CBRF ADVANCED AGED (312) 462-4462 Class: CNA 444 MERTON AVE IRREVERSIBLE DEMENTIA/ALZHEIM HARTLAND WI 53029 THOMAS OSTROM Gender - Capacity: M/F - 36 (262) 367-1311 Sarah Ledger 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/7,000 PHYSICALLY DISABLED County: WAUKESHA CHICAGO IL 60606 Initial License: 03/29/2016 TERMINALLY ILL HARTLAND TERRACE (0012378) HARTLAND TERRACE II LLC Type: CBRF HCBS COMPLIANT (262) 424-0180 Class: CNA 327B NORTH AVE ADVANCED AGED HARTLAND WI 53029 JENNIFER MCLEOD Gender - Capacity: M/F - 22 (262) 369-4391 JENNIFER MCLEOD 327B NORTH AVE Low/High rate: 7,500/8,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA HARTLAND WI 53029 Initial License: 05/01/2008 HERITAGE COURT (0010630) HERITAGE ASSISTED LIVING Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA N48 W14250 HAMPTON AVE IRREVERSIBLE DEMENTIA/ALZHEIM MENOMONEE FALLS WI 53051 Milo Pinkerton Gender - Capacity: M/F - 36 (262) 781-6930 Elizabeth Kowalsky 7901 W NATIONAL AVE Low/High rate: 3,800/4,600 PUBLIC FUNDING County: WAUKESHA WEST ALLIS WI 53214 Initial License: 10/21/2004 HERITAGE COURT (0010630) HERITAGE ASSISTED LIVING Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA N48 W14250 HAMPTON AVE IRREVERSIBLE DEMENTIA/ALZHEIM MENOMONEE FALLS WI 53051 Milo Pinkerton Gender - Capacity: M/F - 36 (262) 781-6930 Elizabeth Kowalsky 7901 W NATIONAL AVE Low/High rate: 3,800/4,600 PUBLIC FUNDING County: WAUKESHA WEST ALLIS WI 53214 Initial License: 10/21/2004

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 150 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HERITAGE COURT (0010630) HERITAGE ASSISTED LIVING Type: CBRF HCBS COMPLIANT (952) 351-4540 Class: CNA N48 W14250 HAMPTON AVE IRREVERSIBLE DEMENTIA/ALZHEIM MENOMONEE FALLS WI 53051 Milo Pinkerton Gender - Capacity: M/F - 36 (262) 781-6930 Elizabeth Kowalsky 7901 W NATIONAL AVE Low/High rate: 3,800/4,600 PUBLIC FUNDING County: WAUKESHA WEST ALLIS WI 53214 Initial License: 10/21/2004 HERITAGE COURT DEER CREEK (0009763) HERITAGE 2 LLC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM (952) 351-4542 Class: CNA 3585 S 147TH ST PUBLIC FUNDING NEW BERLIN WI 53151 Milo Pinkerton Gender - Capacity: M/F - 33 (262) 789-6600 Lori Lutze 7901 W NATIONAL AVE Low/High rate: 4,600/7,000 County: WAUKESHA WEST ALLIS WI 53214 Initial License: 02/05/2003 HERITAGE COURT WAUKESHA (0015285) HERITAGE 13 LLC Type: CBRF HCBS COMPLIANT (982) 351-4542 Class: CNA 1831 MEADOW LANE IRREVERSIBLE DEMENTIA/ALZHEIM PEWAUKEE WI 53072 Milo Pinkerton Gender - Capacity: M/F - 38 (262) 542-3434 Shaun Lynch 7901 W NATIONAL AVE Low/High rate: 4,800/7,500 County: WAUKESHA WEST ALLIS WI 53214 Initial License: 10/08/2014 HERITAGE COURT WAUKESHA (0015285) HERITAGE 13 LLC Type: CBRF HCBS COMPLIANT (982) 351-4542 Class: CNA 1831 MEADOW LANE IRREVERSIBLE DEMENTIA/ALZHEIM PEWAUKEE WI 53072 Milo Pinkerton Gender - Capacity: M/F - 38 (262) 542-3434 Shaun Lynch 7901 W NATIONAL AVE Low/High rate: 4,800/7,500 County: WAUKESHA WEST ALLIS WI 53214 Initial License: 10/08/2014 HERITAGE COURT WAUKESHA (0015285) HERITAGE 13 LLC Type: CBRF HCBS COMPLIANT (982) 351-4542 Class: CNA 1831 MEADOW LANE IRREVERSIBLE DEMENTIA/ALZHEIM PEWAUKEE WI 53072 Milo Pinkerton Gender - Capacity: M/F - 38 (262) 542-3434 Shaun Lynch 7901 W NATIONAL AVE Low/High rate: 4,800/7,500 County: WAUKESHA WEST ALLIS WI 53214 Initial License: 10/08/2014 HERITAGE ELM GROVE (0015092) HERITAGE ASSISTED LIVING LLC Type: CBRF ADVANCED AGED (262) 786-5800 Class: CNA 800 WALL ST IRREVERSIBLE DEMENTIA/ALZHEIM ELM GROVE WI 53122 Milo Pinkerton Gender - Capacity: M/F - 89 (262) 786-5800 Katherine Cavazos 7901 W NATIONAL AVE Low/High rate: 3,400/6,400 County: WAUKESHA WEST ALLIS WI 53214 Initial License: 06/05/2014 HERITAGE LAKE COUNTRY (0016506) HSL 15 LLC Type: CBRF ADVANCED AGED (952) 351-4540 Class: CNA 2975 VILLAGE SQUARE DR IRREVERSIBLE DEMENTIA/ALZHEIM HARTLAND WI 53029 Milo Pinkerton Gender - Capacity: M/F - 72 (262) 367-2975 Shaun Lynch 7901 W NATIONAL AVE Low/High rate: 4,890/9,000 County: WAUKESHA WEST ALLIS WI 53214 Initial License: 05/01/2017 HERITAGE MUSKEGO (0017261) HSL 16 LLC Type: CBRF ADVANCED AGED (952) 351-4540 Class: CNA S64 W13780 JANESVILLE RD IRREVERSIBLE DEMENTIA/ALZHEIM MUSKEGO WI 53150 PIERRE VERGER Gender - Capacity: M/F - 85 (414) 425-7155 Tammy Roth-Bottini 7901 W NATIONAL AVE Low/High rate: 4,800/5,600 TERMINALLY ILL County: WAUKESHA WEST ALLIS WI 53214 Initial License: 12/10/2018 HIL CANAAN (0009981) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AA 443 FREEMAN ST EMOTIONALLY DISTURBED/MENTAL WAUKESHA WI 53189 Ashley Williams Gender - Capacity: M/F - 5 (262) 524-8467 Pauline Glainyl-Buehler 1249 RUSSETT COURT Low/High rate: 9,420/9,420 PUBLIC FUNDING County: WAUKESHA GREEN BAY WI 54313 Initial License: 03/18/2003 HIL DEER HAVEN (0009962) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CNA N26 W26286 QUAIL HOLLOW RD DEVELOPMENTALLY DISABLED PEWAUKEE WI 53072 Ashley Williams Gender - Capacity: M/F - 8 (262) 695-7135 PAULINE GLAINYK-BUEHLER 1249 RUSSETT COURT Low/High rate: 5,348/5,348 PUBLIC FUNDING County: WAUKESHA GREEN BAY WI 54313 Initial License: 03/01/2003 HIL FLEETFOOT (0013201) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AA 1316/1318 FLEETFOOT DR DEVELOPMENTALLY DISABLED WAUKESHA WI 53186 Ashley Williams Gender - Capacity: M/F - 8 (262) 408-2811 Pauline Blainyk-Buelhler 1249 RUSSETT COURT Low/High rate: 3,735/3,735 PUBLIC FUNDING County: WAUKESHA GREEN BAY WI 54313 Initial License: 05/12/2010 HIL JORDAN HOUSE (0009759) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AA 2165 LAURA LN EMOTIONALLY DISTURBED/MENTAL WAUKESHA WI 53186 Ashley Williams Gender - Capacity: M/F - 8 (262) 443-5060 Pauline Glainyl-Buehler 1249 RUSSETT COURT Low/High rate: 4,292/4,292 PUBLIC FUNDING County: WAUKESHA GREEN BAY WI 54313 Initial License: 01/01/2002

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 151 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

HIL PEWAUKEE HOUSE (0009704) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: AA 303 OAKTON AVE EMOTIONALLY DISTURBED/MENTAL PEWAUKEE WI 53072 Ashley Williams Gender - Capacity: M/F - 8 (262) 691-3942 Pauline Glainyl-Buehler 1249 RUSSETT COURT Low/High rate: 4,780/4,780 PUBLIC FUNDING County: WAUKESHA GREEN BAY WI 54313 Initial License: 01/01/2002 HIL SKYLINE HOUSE (0009690) HOMES FOR INDEPENDENT LIVING OF WI LLC Type: CBRF HCBS COMPLIANT (262) 569-5520 Class: CNA 5265 S SKYLINE DR DEVELOPMENTALLY DISABLED NEW BERLIN WI 53151 Ashley Williams Gender - Capacity: M/F - 6 (414) 235-3359 Ryan Larsen 1249 RUSSETT COURT Low/High rate: 5,698/5,698 PHYSICALLY DISABLED County: WAUKESHA GREEN BAY WI 54313 Initial License: 01/01/2002 PUBLIC FUNDING HILLSIDE TERRACE CBRF (0018069) LUTHERAN HOMES OF OCONOMOWOC Type: CBRF ADVANCED AGED (262) 567-8341 Class: CNA 1305 WEST WISCONSIN AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM OCONOMOWOC WI 53066 BRYAN POLINSKE Gender - Capacity: M/F - 14 (262) 567-8341 BRYAN POLINSKE 1305 WEST WISCONSIN AVENUE Low/High rate: 5,500/8,500 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 07/01/2020 IRIS HEALTH CLINIC LLC (0017382) IRIS HEALTH CLINIC LLC Type: CBRF HCBS COMPLIANT (971) 334-3150 Class: CA 260 S ELMGROVE ROAD ALCOHOL/DRUG DEPENDENT BROOKFIELD WI 53005 PETER BRUNZELLE Gender - Capacity: M/F - 12 (971) 334-3150 PETER BRUNZELLE 260 S ELMGROVE ROAD Low/High rate: 5,400/26,940 CORRECTIONAL CLIENTS County: WAUKESHA BROOKFIELD WI 53005 Initial License: 04/13/2020 EMOTIONALLY DISTURBED/MENTAL PREGNANT WOMEN/COUNSELLING LAKEWOOD ALZHEIMERS SPECIAL CARE CENTER (00177 SUNSHINE RETIREMENT LLC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM 4065 N CALHOUN RD (541) 323-3725 Class: CNA BROOKFIELD WI 53005 Cheyne Bader Gender - Capacity: M/F - 65 (262) 373-0848 LAURIAL KING 41080 SW Mount Bachelor Drive Suite 200 Low/High rate: 4,995/6,600 County: WAUKESHA Bend OR 97702 Initial License: 10/10/2019 LANG HOME (0010990) PRADER WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-4848 Class: AA 1234 NEWPORT DR DEVELOPMENTALLY DISABLED OCONOMOWOC WI 53066 Vicki Raml-Glider Gender - Capacity: M/F - 8 (262) 567-5835 Kristina Lumby PO BOX 278 Low/High rate: 6,250/6,250 County: WAUKESHA DOUSMAN WI 53118 Initial License: 08/02/2005 LEGACY ASSISTED LIVING (0017088) PARKSIDE OF LEGACY LLC Type: CBRF HCBS COMPLIANT (847) 779-8501 Class: CNA N26W26511 COLLEGE AVE ADVANCED AGED PEWAUKEE WI 53072 ASHLEY APAZELLER Gender - Capacity: M/F - 32 (262) 696-8252 Nicole Turluck N26W26511 COLLEGE AVE Low/High rate: 4,200/6,200 DEVELOPMENTALLY DISABLED County: WAUKESHA PEWAUKEE WI 53072 Initial License: 04/16/2018 IRREVERSIBLE DEMENTIA/ALZHEIM TERMINALLY ILL LINDENCOURT MUKWONAGO (310452) LINDENGROVE INC Type: CBRF HCBS COMPLIANT (262) 797-4600 Class: CNA 845 E VETERANS WAY ADVANCED AGED MUKWONAGO WI 53149 JEANNE PICCIONE Gender - Capacity: M/F - 24 (262) 363-6830 SUZANNE WHITTY 845 E Veterans Way Low/High rate: 5,500/6,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA MUKWONAGO WI 53149 Initial License: 09/23/1996 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin LINDENCOURT NEW BERLIN (0014615) LINDENGROVE INC Type: CBRF HCBS COMPLIANT (262) 797-4600 Class: CNA 13705 W FIELDPOINTE DRIVE ADVANCED AGED NEW BERLIN WI 53151 Bart Smith Gender - Capacity: M/F - 49 (262) 796-3660 Rachel Russell 13755 W FIELDPOINTE DR Low/High rate: 5,150/6,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA NEW BERLIN WI 53151 Initial License: 08/20/2013 PUBLIC FUNDING Association Approval: LeadingAge Wisconsin LODGES AT LINDENGROVE (THE) (0017083) LINDENGROVE INC Type: CBRF ADVANCED AGED (262) 797-4600 Class: CNA 425 N UNIVERSITY DR PHYSICALLY DISABLED WAUKESHA WI 53188 SUZANNE WHITTY Gender - Capacity: M/F - 20 (262) 524-6400 SUZANNE WHITTY 425 N UNIVERSITY DR Low/High rate: 535/6,950 County: WAUKESHA WAUKESHA WI 53188 Initial License: 05/09/2018 Association Approval: LeadingAge Wisconsin LSS GENESIS HALFWAY HOUSE (310399) LUTHERAN SOC SERV OF WI & UPPER MI INC Type: CBRF ALCOHOL/DRUG DEPENDENT 1002 MOTOR AVE (800) 488-5181 Class: AA WAUKESHA WI 53188 PAULA UPP Gender - Capacity: M - 12 (262) 544-0711 Patrick Reilly 3003 N Richmond St Low/High rate: 3,080/3,410 County: WAUKESHA Appleton WI 54911 Initial License: 03/01/1980

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 152 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LYNNWOOD OF DELAFIELD (0009711) HEALTHSPAN INC Type: CBRF ADVANCED AGED (414) 541-4700 Class: CNA W302 N1632 MAPLE AVE IRREVERSIBLE DEMENTIA/ALZHEIM PEWAUKEE WI 53072 LORI PAPROCKI Gender - Capacity: M/F - 10 (262) 367-9677 HOLLY NYGRO 5520 W FOREST HOME AVE Low/High rate: 5,500/6,500 PHYSICALLY DISABLED County: WAUKESHA GREENFIELD WI 53220 Initial License: 04/07/2003 MARION HOUSE (310472) VOLUNTEERS OF AMERICA WISCONSIN Type: CBRF HCBS COMPLIANT (414) 847-1515 Class: CNA 401 S PRAIRIE ST ADVANCED AGED WAUKESHA WI 53186 Alissa Kempken Gender - Capacity: M/F - 8 (262) 547-0870 Christopher Otte-Voigt 1661 N WATER ST, SUITE 401 Low/High rate: 4,522/5,323 CORRECTIONAL CLIENTS County: WAUKESHA MILWAUKEE WI 53202 Initial License: 04/30/1982 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING MATTHEWS OF PEWAUKEE CBRF (0014154) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (321) 462-4462 Class: CNA 1109 CECELIA DR ADVANCED AGED PEWAUKEE WI 53072-2524 THOMAS OSTROM Gender - Capacity: M/F - 20 (262) 695-6413 Zach Walczak 101 N WACKER DRIVE STE 616 Low/High rate: 3,270/7,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA CHICAGO IL 60606 Initial License: 06/15/2012 PHYSICALLY DISABLED TERMINALLY ILL MISSION CREEK (0018673) MISSION CREEK SENIOR CARE LLC Type: CBRF HCBS COMPLIANT (773) 825-3336 Class: CNA 3217 FIDDLERS CREEK DRIVE ADVANCED AGED WAUKESHA WI 53188 MORDY POLSTEIN Gender - Capacity: M/F - 97 (262) 832-1020 CHRISTINE DENTON 8170 MCCORMICK BLVD 112 Low/High rate: 2,895/8,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA SKOKIE IL 60076 Initial License: 08/02/2021 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL MUSKEGO CBRF (BROTOLOC) (0013081) BROTOLOC SOUTH INC Type: CBRF HCBS COMPLIANT (262) 473-0480 Class: ANA S68 W12699 BRISTLECONE LANE ADVANCED AGED MUSKEGO WI 53150 Christopher Cohen Gender - Capacity: M/F - 6 (414) 525-0307 Jessie Oberhofer 209 S TAFT ST Low/High rate: 4,563/9,125 DEVELOPMENTALLY DISABLED County: WAUKESHA WHITEWATER WI 53190 Initial License: 01/01/2010 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY MUSKEGO NURSING HOME (310477) MUSKEGO NURSING HOME INC Type: CBRF ADVANCED AGED (262) 679-0246 Class: CNA S77 W18690 JANESVILLE RD IRREVERSIBLE DEMENTIA/ALZHEIM MUSKEGO WI 53150 HAROLD SWANTO Gender - Capacity: M/F - 17 (262) 679-0246 HAROLD SWANTO S77 W18690 JANESVILLE RD Low/High rate: 4,000/4,500 PHYSICALLY DISABLED County: WAUKESHA MUSKEGO WI 53150 Initial License: 12/01/1979 TERMINALLY ILL NEW PERSPECTIVE BROOKFIELD (0011457) NEW PERSPECTIVES FUND 1, LLC Type: CBRF HCBS COMPLIANT (952) 746-3630 Class: CNA 16720 W GREENFIELD AVE ADVANCED AGED BROOKFIELD WI 53005 RYAN NOVACZYK Gender - Capacity: M/F - 16 (262) 827-9017 Anna Angle 5900 Clearwater Dr. STE 500 Low/High rate: 4,245/4,675 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA Minnetonka MN 55343 Initial License: 11/02/2006 PUBLIC FUNDING NEW PERSPECTIVE BROOKFIELD (0011457) NEW PERSPECTIVES FUND 1, LLC Type: CBRF HCBS COMPLIANT (952) 746-3630 Class: CNA 16720 W GREENFIELD AVE ADVANCED AGED BROOKFIELD WI 53005 RYAN NOVACZYK Gender - Capacity: M/F - 16 (262) 827-9017 Anna Angle 5900 Clearwater Dr. STE 500 Low/High rate: 4,245/4,675 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA Minnetonka MN 55343 Initial License: 11/02/2006 PUBLIC FUNDING NEW PERSPECTIVE WAUKESHA (0018236) WAUKESHA OPS LLC Type: CBRF HCBS COMPLIANT (952) 241-8211 Class: CNA 1701 EAST BROADWAY ADVANCED AGED WAUKESHA WI 53186 PAM ENGLE Gender - Capacity: M/F - 60 (262) 955-1998 ANTHONY VAUGHNS 5900 CLEARWATER DRIVE STE 500 Low/High rate: 3,800/5,325 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA MINNETONKA MN 55343 Initial License: 09/15/2020 PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA OAK HILL TERRACE V LLC (310668) OAK HILL TERRACE V LLC Type: CBRF HCBS COMPLIANT (262) 548-5965 Class: CNA 1805 KENSINGTON DR ADVANCED AGED WAUKESHA WI 53188 BETH ANDERSON Gender - Capacity: M/F - 128 (262) 548-1457 ROBERT BEST 1805 KENSINGTON DR Low/High rate: 1,710/5,515 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA WAUKESHA WI 53188 Initial License: 10/13/1986 PUBLIC FUNDING WAIVER CERTIFIED INDEPENDENT C

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 153 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

OCD CENTER AT CEDAR RIDGE (0014809) ROGERS MEMORIAL HOSPITAL Type: CBRF EMOTIONALLY DISTURBED/MENTAL 3011 N CEDAR RIDGE ROAD (262) 646-4411 Class: AA OCONOMOWOC WI 53066 Maeve O'Neil Gender - Capacity: M/F - 28 (262) 646-4411 KIMBERLY EFFERTZ 34700 VALLEY ROAD Low/High rate: 30,900/30,900 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 12/11/2013 RENAISSANCE MEMORY CARE OF NEW BERLIN (0017828 RENAISSANCE SENIOR LIVING LLC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM 21903 W NATIONAL AVE (414) 791-9935 Class: CNA NEW BERLIN WI 53146 SHEILA MARIE BALISTRERI Gender - Capacity: M/F - 8 (414) 791-9935 SHEILA MARIE BALISTRERI 21903 W NATIONAL AVE Low/High rate: 6,900/7,850 County: WAUKESHA NEW BERLIN WI 53146 Initial License: 09/30/2019 RIVERLINE HOME (0014460) PRADER WILLI HOMES OF OCONOMOWOC Type: CBRF HCBS COMPLIANT (262) 569-4848 Class: AA 1314 N RIVERLINE DR DEVELOPMENTALLY DISABLED OCONOMOWOC WI 53066 MARGUERITE RUPNOW Gender - Capacity: M/F - 8 (262) 468-5095 MARGUERITE RUPNOW PO BOX 278 Low/High rate: 5,675/5,675 County: WAUKESHA DOUSMAN WI 53118 Initial License: 01/24/2013 RIVERSIDE LODGE (310510) WISCONSIN MASONIC HOME INC Type: CBRF HCBS COMPLIANT (262) 965-7397 Class: CNA 410 N MAIN ST ADVANCED AGED DOUSMAN WI 53118 Cayla Piehl Gender - Capacity: M/F - 20 (262) 965-7397 PIEHL CAYLA 410 N MAIN ST Low/High rate: 4,527/7,917 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA DOUSMAN WI 53118 Initial License: 11/14/1995 Association Approval: LeadingAge Wisconsin RIVERVIEW VILLAGE SENIOR LIVING (0015619) RIVERVIEW VILLAGE SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (262) 255-2557 Class: CNA W176 N9430 RIVER CREST DR ADVANCED AGED MENOMONEE FALLS WI 53051 Lee Johnson Gender - Capacity: M/F - 48 (262) 255-2557 Tiffany Morth 1675 E Riverside Dr. STE 150 Low/High rate: 4,300/6,750 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA Eagle ID 85282 Initial License: 08/01/2015 PUBLIC FUNDING Association Approval: WiCAL ROBINS LANDING AT BROOKFIELD (0018390) NOBLE SENIOR LIVING AT BROOKFIELD LLC Type: CBRF ADVANCED AGED (732) 403-3151 Class: CNA 2800 NORTH CALHOUN ROAD DEVELOPMENTALLY DISABLED BROOKFIELD WI 53005 LORNE SCHECHTER Gender - Capacity: M/F - 52 (262) 402-9700 DAWN WILERT 137 BROAD STREET Low/High rate: 3,080/7,500 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA RED BANK NJ 07701 Initial License: 03/10/2021 IRREVERSIBLE DEMENTIA/ALZHEIM ROGERS MEM HOSP HERRINGTON RECOVERY CENTER ROGERS MEMORIAL HOSPITAL Type: CBRF ALCOHOL/DRUG DEPENDENT 34700 VALLEY RD (262) 646-4411 Class: AA OCONOMOWOC WI 53066 Maeve O'Neil Gender - Capacity: M/F - 20 (262) 646-4411 KIMBERLY EFFERTZ 34700 VALLEY RD Low/High rate: 30,480/30,480 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 09/28/2009 ROGERS MEM HOSP TURTLE POND RECOVERY CENTER ROGERS MEMORIAL HOSPITAL Type: CBRF EMOTIONALLY DISTURBED/MENTAL 34700 VALLEY RD (262) 646-4411 Class: AA OCONOMOWOC WI 53066 Maeve O'Neil Gender - Capacity: M/F - 33 (262) 646-4411 KIMBERLY EFFERTZ 34700 VALLEY RD Low/High rate: 31,555/3,155,52 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 11/10/1997 ROGERS MEMORIAL HOSPITAL DELAFIELD B (0012061) ROGERS MEMORIAL HOSPITAL Type: CBRF EMOTIONALLY DISTURBED/MENTAL W325 OAKWOOD DR (262) 646-4411 Class: AA DELAFIELD WI 53018 Maeve O'Neill Gender - Capacity: M/F - 16 (262) 646-4411 KIMBERLY EFFERTZ 34700 VALLEY RD Low/High rate: 33,309/33,309 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 02/08/2008 SAMSON HOUSE (0013581) MATT TALBOT RECOVERY SERVICES, INC Type: CBRF HCBS COMPLIANT (414) 342-5474 Class: AA 611 N GRAND AVE ALCOHOL/DRUG DEPENDENT WAUKESHA WI 53186 KARL RAJANI Gender - Capacity: M/F - 8 (414) 306-7007 ANTONIO DESHAZOR PO BOX 20007 Low/High rate: 2,572/2,658 DEVELOPMENTALLY DISABLED County: WAUKESHA GREENFIELD WI 53220-0007 Initial License: 02/03/2011 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING TRAUMATIC BRAIN INJURY SHOREHAVEN MEMORY CARE (0013899) LUTHERAN HOMES OF OCONOMOWOC INC Type: CBRF ADVANCED AGED (262) 567-8341 Class: CS 1305 W WISCONSIN AVE IRREVERSIBLE DEMENTIA/ALZHEIM OCONOMOWOC WI 53066 Emily Karls Gender - Capacity: M/F - 26 (262) 567-8341 Michaela Gygax 1305 W WISCONSIN AVE Low/High rate: 6,180/9,080 County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 03/01/2012

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 154 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs Association Approval: LeadingAge Wisconsin SKY RESIDENTIAL BROOKSIDE (0009132) SKY RESIDENTIAL SERVICES INC Type: CBRF HCBS COMPLIANT (414) 916-2710 Class: CNA 2405 S BROOKSIDE PKWY ADVANCED AGED NEW BERLIN WI 53151-2905 KIM NGUYEN Gender - Capacity: M/F - 8 (262) 821-1406 KIM NGUYEN N94 W20846 SCHLEI RD Low/High rate: 3,850/7,750 ALCOHOL/DRUG DEPENDENT County: WAUKESHA MENOMONEE FALLS WI 53051 Initial License: 11/02/2000 DEVELOPMENTALLY DISABLED EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY ST COLETTA OF WI HYDRITE (0013998) ST COLETTA OF WISCONSIN Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 2309 RUSTIC WOODS CT DEVELOPMENTALLY DISABLED WAUKESHA WI 53188 TED BEHNCKE Gender - Capacity: M/F - 8 (920) 220-9609 Tanya Staude N4637 COUNTY ROAD Y Low/High rate: 4,587/4,700 PUBLIC FUNDING County: WAUKESHA JEFFERSON WI 53549 Initial License: 02/24/2012 ST COLETTA OF WI NORRIS (0013999) ST COLETTA OF WISCONSIN Type: CBRF HCBS COMPLIANT (920) 674-4330 Class: CNA 405 PRAIRIE SONG DR DEVELOPMENTALLY DISABLED WAUKESHA WI 53188 TED BEHNCKE Gender - Capacity: M/F - 8 (920) 220-9609 Tanya Staude N4637 COUNTY ROAD Y Low/High rate: 4,727/6,009 PUBLIC FUNDING County: WAUKESHA JEFFERSON WI 53549 Initial License: 02/20/2012 STEPPING STONE (0010475) PRADER WILLI HOMES OF OCONOMOWOC LLC Type: CBRF HCBS COMPLIANT (262) 569-5515 Class: CS 700-702 HICKORY CREEK DR DEVELOPMENTALLY DISABLED OCONOMOWOC WI 53066 Vicki Raml-Glider Gender - Capacity: M/F - 8 (262) 569-4822 MARGUERITE RUPNOW PO BOX 278 Low/High rate: 9,054/9,054 County: WAUKESHA DOUSMAN WI 53118 Initial License: 04/19/2004 SUMMIT HOUSE (0011511) VOLUNTEERS OF AMERICA WISCONSIN Type: CBRF HCBS COMPLIANT (414) 847-1515 Class: AA 910 SUMMIT AVE DEVELOPMENTALLY DISABLED WAUKESHA WI 53188 Alissa Kempken Gender - Capacity: M/F - 6 (414) 928-5550 AINSLEY MORLEY 1661 N WATER ST STE 401 Low/High rate: 4,038/4,650 EMOTIONALLY DISTURBED/MENTAL County: WAUKESHA MILWAUKEE WI 53202 Initial License: 09/21/2006 PUBLIC FUNDING TOWNER CREST ARBOR MEMORY CARE (0017947) PHW OCONOMOWOC INC Type: CBRF ADVANCED AGED (414) 793-8014 Class: CNA 1205 EAST LISBON ROAD IRREVERSIBLE DEMENTIA/ALZHEIM OCONOMOWOC WI 53066 KARI AJACK Gender - Capacity: M/F - 20 (414) 793-8014 Sandi Bednarski 222 PARK PLACE Low/High rate: 5,625/8,164 County: WAUKESHA WAUKESHA WI 53186 Initial License: 04/07/2020 Association Approval: LeadingAge Wisconsin TOWNER CREST COMMONS ASSISTED LIVING (0017948) PHW OCONOMOWOC INC Type: CBRF ADVANCED AGED 1205 EAST LISBON ROAD (414) 793-8014 Class: CNA OCONOMOWOC WI 53066 KARI AJACK Gender - Capacity: M/F - 32 (414) 793-8014 Sandi Bednarski 222 PARK PLACE Low/High rate: 3,375/7,792 County: WAUKESHA WAUKESHA WI 53186 Initial License: 04/07/2020 Association Approval: LeadingAge Wisconsin TUDOR OAKS WINDSOR GARDENS (0013745) AMERICAN BAPTIST HOMES OF THE MIDWEST Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM S77 W12929 MCSHANE DR (800) 536-3175 Class: CNA MUSKEGO WI 53150 Jeanne Piccione Gender - Capacity: M/F - 22 (414) 529-0100 Jeanne Piccione S77 W12929 MCSHANE DR Low/High rate: 6,407/6,839 County: WAUKESHA MUSKEGO WI 53150 Initial License: 08/08/2011 Association Approval: LeadingAge Wisconsin VESTA MEMORY CARE (0017742) VESTA MEMORY CARE LLC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM 3965 BRADEE RD (414) 234-5550 Class: CNA BROOKFIELD WI 53005 JAYNE ZIEHM Gender - Capacity: M/F - 8 (414) 234-5550 JAYNE ZIEHM 6317 W LLOYD ST Low/High rate: 6,900/8,050 County: WAUKESHA WAUWATOSA WI 53213 Initial License: 10/02/2019

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 155 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

VICTORIAN CASTLE (0011711) CASTLE SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (414) 427-1655 Class: CS 19700 W CLEVELAND AVE ADVANCED AGED NEW BERLIN WI 53146 Michelle Green Gender - Capacity: M/F - 8 (262) 549-3130 Michelle Green 13050 W Cleveland AVe Low/High rate: 3,800/5,000 DEVELOPMENTALLY DISABLED County: WAUKESHA New Berlin WI 53151 Initial License: 01/03/2007 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA VIEW AT PINE RIDGE (THE) (0015699) HERITAGE PROPERTIES INC Type: CBRF HCBS COMPLIANT (262) 894-6828 Class: CNA 1010 PINE RIDGE COURT ADVANCED AGED OCONOMOWOC WI 53066 KIMBERLY OTTE-MAY Gender - Capacity: M/F - 26 (262) 468-7711 Emily Kotlarek 1010 PINE RIDGE COURT Low/High rate: 4,924/10,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 08/25/2015 VIEW AT PINE RIDGE II (THE) (0016659) HERITAGE PROPERTIES INC Type: CBRF HCBS COMPLIANT (262) 894-6828 Class: CNA 1030 PINE RIDGE COURT ADVANCED AGED OCONOMOWOC WI 53066 KIMBERLY OTTE MAY Gender - Capacity: M/F - 46 (262) 468-7711 Emily Kotlarek 1010 PINE RIDGE COURT Low/High rate: 4,563/11,102 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA OCONOMOWOC WI 53066 Initial License: 05/23/2017 PHYSICALLY DISABLED VISTA POINT III (0016846) ALISAN INC Type: CBRF ADVANCED AGED (262) 689-1711 Class: CNA W180 N8240 TOWN HALL RD IRREVERSIBLE DEMENTIA/ALZHEIM MENOMONEE FALLS WI 53051 JILL GEIDEL Gender - Capacity: M/F - 26 (262) 689-1711 JILL GEIDEL 7430 Aurora Road Low/High rate: 5,000/6,500 PHYSICALLY DISABLED County: WAUKESHA West Bend WI 53090 Initial License: 11/29/2017 TERMINALLY ILL VISTA POINTE (0014822) ALISAN INC Type: CBRF HCBS COMPLIANT (262) 689-1711 Class: CNA W180 N8200 TOWN HALL ROAD ADVANCED AGED MENOMONEE FALLS WI 53051 JILL GEIDEL Gender - Capacity: M/F - 25 (262) 251-1976 JILL GEIDEL 7430 Aurora Road Low/High rate: 5,000/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA West Bend WI 53090 Initial License: 10/10/2013 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL VISTA POINTE II (0015261) ALISAN INC Type: CBRF ADVANCED AGED (262) 689-1711 Class: CNA W180 N8220 TOWN HALL RD IRREVERSIBLE DEMENTIA/ALZHEIM MENOMONEE FALLS WI 53051 JILL GEIDEL Gender - Capacity: M/F - 26 (262) 251-1231 JILL GEIDEL 7430 Aurora Road Low/High rate: 5,000/6,500 PHYSICALLY DISABLED County: WAUKESHA West Bend WI 53090 Initial License: 10/15/2014 TERMINALLY ILL WOODSIDE TERRACE ASSISTED LIVING (0017406) SUNRISE TERRACE LLC Type: CBRF HCBS COMPLIANT (262) 337-3386 Class: CS 1820 WESTMOOR TERRACE ADVANCED AGED ELM GROVE WI 53122 RENAE WEGNER Gender - Capacity: M/F - 8 (262) 649-3624 RENAE WEGNER 1803 E JUNIPER WAY Low/High rate: 4,500/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUKESHA HARTLAND WI 53029 Initial License: 05/28/2019 BEACON HOUSE (0013395) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: AS 307 W COOK ST ADVANCED AGED NEW LONDON WI 54961 BARB SALEMI Gender - Capacity: M - 8 (920) 982-7352 BARBARA HAMEISTER 424 WASHINGTON AVE Low/High rate: 3,428/5,765 DEVELOPMENTALLY DISABLED County: WAUPACA OSHKOSH WI 54901 Initial License: 08/01/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING TRAUMATIC BRAIN INJURY BETHANY HOME INC (0016965) BETHANY HOME INC Type: CBRF ADVANCED AGED (715) 258-5521 Class: CNA 1226 BERLIN ST IRREVERSIBLE DEMENTIA/ALZHEIM WAUPACA WI 54981 ANDREA WANTY Gender - Capacity: M/F - 49 (715) 258-5521 PAULINE DARLING 1226 BERLIN ST Low/High rate: 4,500/6,500 PHYSICALLY DISABLED County: WAUPACA WAUPACA WI 54981 Initial License: 03/08/2018 TERMINALLY ILL Association Approval: LeadingAge Wisconsin

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 156 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CARE PARTNERS CLINTONVILLE I (0015437) CARE PARTNERS ASSISTED LIVING Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 59 INDUSTRIAL AVE ADVANCED AGED CLINTONVILLE WI 54929 JASON LINDEMANN Gender - Capacity: M/F - 18 (715) 460-3466 TRISHA BESSETTE PO BOX 3006 Low/High rate: 3,800/4,650 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUPACA OSHKOSH WI 54903 Initial License: 02/16/2015 PHYSICALLY DISABLED TERMINALLY ILL CARE PARTNERS CLINTONVILLE II (0017857) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 61 INDUSTRIAL AVE ADVANCED AGED CLINTONVILLE WI 54929 JASON LINDEMANN Gender - Capacity: M/F - 26 (715) 460-3466 TRISHA BESSETTE PO BOX 3006 Low/High rate: 4,900/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUPACA OSHKOSH WI 54903 Initial License: 11/25/2019 PHYSICALLY DISABLED TERMINALLY ILL GARDEN PARK HOUSE (410133) PRO HEALTH CONSUL INC Type: CBRF HCBS COMPLIANT (715) 258-2191 Class: CS 109 WEST LAKE STREET ADVANCED AGED WAUPACA WI 54981 CYNTHIA OERTER Gender - Capacity: M/F - 14 (715) 258-2191 CYNTHIA OERTER 109 WEST LAKE STREET Low/High rate: 2,128/3,720 EMOTIONALLY DISTURBED/MENTAL County: WAUPACA WAUPACA WI 54981 Initial License: 03/14/1994 KINDREDHEARTS CLINTONVILLE (0009720) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 76 GREEN TREE ROAD ADVANCED AGED CLINTONVILLE WI 54929 DAWN MCCONNELL Gender - Capacity: M/F - 20 (715) 823-7300 DOUG HENNIG 76 GREEN TREE ROAD Low/High rate: 3,605/4,016 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUPACA CLINTONVILLE WI 54929 Initial License: 10/02/2002 PUBLIC FUNDING KINDREDHEARTS NEW LONDON (0009724) PARTNERS IN COMMUNITY ELDERCARE LLC Type: CBRF HCBS COMPLIANT (608) 442-8005 Class: CNA 1706 TAUBEL ROAD ADVANCED AGED NEW LONDON WI 54961 DOUG HENNIG Gender - Capacity: M/F - 19 (920) 982-0686 BRENDA LUNDE 1706 TAUBEL ROAD Low/High rate: 3,700/4,121 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUPACA NEW LONDON WI 54961 Initial License: 10/02/2002 PUBLIC FUNDING MANAWA ASSISTED LIVING (0014496) MANAWA COMMUNITY NURSING CENTER INC Type: CBRF ADVANCED AGED (920) 596-2566 Class: CNA 401 EAST 4TH ST IRREVERSIBLE DEMENTIA/ALZHEIM MANAWA WI 54949 PHILIP CASTLEBERG Gender - Capacity: M/F - 10 (920) 596-2566 PHILIP CASTLEBERG 400 EAST 4TH ST Low/High rate: 2,500/5,000 PHYSICALLY DISABLED County: WAUPACA MANAWA WI 54949 Initial License: 04/29/2015 MCKINLEY HOUSE (0013397) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 75 N PARK ST ADVANCED AGED CLINTONVILLE WI 54927 BARB SALEMI Gender - Capacity: M/F - 7 (715) 823-3032 BARBARA HAMEISTER 424 WASHINGTON AVE Low/High rate: 4,352/5,914 DEVELOPMENTALLY DISABLED County: WAUPACA OSHKOSH WI 54901 Initial License: 08/01/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY MONARCH MEADOWS AT ST JOSEPH RESIDENCE (00173 ST JOSEPH RESIDENCE INC Type: CBRF ADVANCED AGED (920) 982-5354 Class: CNA 107 E BECKERT ROAD IRREVERSIBLE DEMENTIA/ALZHEIM NEW LONDON WI 54961 GIDGET BLANK Gender - Capacity: M/F - 24 (920) 982-5354 GIDGET BLANK 107 E BECKERT ROAD Low/High rate: 5,250/6,250 PUBLIC FUNDING County: WAUPACA NEW LONDON WI 54961 Initial License: 01/03/2019 TERMINALLY ILL Association Approval: LeadingAge Wisconsin PARK VISTA THE LEGACY (0016379) PARK VISTA SENIOR HOUSING MANAGEMENT L Type: CBRF HCBS COMPLIANT (563) 503-6001 Class: CNA 1403 CHURCHILL ST ADVANCED AGED WAUPACA WI 54981 JULIE LONERGAN Gender - Capacity: M/F - 22 (715) 942-0047 KELLEY ROBINSON 132 6TH AVE S Low/High rate: 6,040/6,970 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUPACA CLINTON IA 52732 Initial License: 10/10/2016 PUBLIC FUNDING TERMINALLY ILL STRONG HAVEN (0009441) MARIE SCHRAMM Type: CBRF HCBS COMPLIANT (920) 867-2801 Class: CS N3501 HWY 110 ADVANCED AGED WEYAUWEGA WI 54983 MARIE SCHRAMM Gender - Capacity: M/F - 7 (920) 867-2801 MARIE SCHRAMM N3501 HWY 110 Low/High rate: 2,714/3,714 ALCOHOL/DRUG DEPENDENT County: WAUPACA WEYAUWEGA WI 54983 Initial License: 09/20/2001 DEVELOPMENTALLY DISABLED PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 157 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

TRINITY TERRACE (410429) ST JOSEPH RESIDENCE INC Type: CBRF HCBS COMPLIANT (920) 982-5354 Class: CNA 1835 DIVISION STREET ADVANCED AGED NEW LONDON WI 54961 GIDGET BLANK Gender - Capacity: M/F - 32 (920) 982-9354 GIDGET BLANK 1835 DIVISION STREET Low/High rate: 4,199/5,225 TERMINALLY ILL County: WAUPACA NEW LONDON WI 54961 Initial License: 10/01/1995 Association Approval: LeadingAge Wisconsin WAUPACA ELDER CARE HOME (0017545) 510 RIVER ST WAUPACA OPERATOR LLC Type: CBRF HCBS COMPLIANT (262) 266-2002 Class: CNA 510 RIVER ST ADVANCED AGED WAUPACA WI 54981 JUDITHA ROUNSEVILLE Gender - Capacity: M/F - 16 (715) 258-9681 JUDITHA ROUNSEVILLE N19W24400 RIVERWOOD DR STE 350 Low/High rate: 2,400/6,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUPACA WAUKESHA WI 53188 Initial License: 05/31/2019 TERMINALLY ILL WHISTLING PINES INC (0012366) JIM/LORENDA ROSIN Type: CBRF HCBS COMPLIANT (920) 229-3664 Class: CNA 121 CTY HWY QQ ADVANCED AGED WAUPACA WI 54981 JIM ROSIN Gender - Capacity: M/F - 12 (715) 256-9193 CINDY WEISENSEL PO BOX 900 Low/High rate: 3,250/4,200 DEVELOPMENTALLY DISABLED County: WAUPACA WAUTOMA WI 54982 Initial License: 04/14/2008 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED WILLOWS (THE) (0017306) IOLA LIVING ASSISTANCE INC Type: CBRF HCBS COMPLIANT (715) 445-2412 Class: CNA 515 W IOLA ST ADVANCED AGED IOLA WI 54945 NICOLE BARRETT Gender - Capacity: M/F - 26 (715) 445-2412 NICOLE BARRETT 185 S CHET KRAUSE DR Low/High rate: 4,160/5,760 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUPACA IOLA WI 54945 Initial License: 04/03/2019 Association Approval: LeadingAge Wisconsin ARBOR PINES INC (0012367) JIM/LARENDA ROSIN Type: CBRF HCBS COMPLIANT (920) 229-3664 Class: CNA 540 W PRAIRIE STREET ADVANCED AGED WAUTOMA WI 54982 JIM ROSIN Gender - Capacity: M/F - 8 (920) 787-4466 CINDY WEISENSEL PO BOX 900 Low/High rate: 3,200/3,800 DEVELOPMENTALLY DISABLED County: WAUSHARA WAUTOMA WI 54982 Initial License: 04/10/2008 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED HEARTLAND HOUSE CBRF (0014477) HEARTLAND HOUSE INC Type: CBRF HCBS COMPLIANT (920) 787-5817 Class: CNA 668 W CUMMINGS RD ADVANCED AGED WAUTOMA WI 54982 JOSIAH GROTHE Gender - Capacity: M/F - 20 (920) 787-1509 REBECCA SCHMIT 668 W CUMMINGS RD Low/High rate: 2,700/4,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUSHARA WAUTOMA WI 54982 Initial License: 01/17/2013 PUBLIC FUNDING HORIZON HOUSE (0017595) HORIZON LIFE SERVICES LLC Type: CBRF HCBS COMPLIANT (414) 581-0582 Class: CNA 402 E DIVISION ST ALCOHOL/DRUG DEPENDENT WAUTOMA WI 54982 KARL RAJANI Gender - Capacity: M/F - 8 (920) 787-9556 MARK CONNELLY PO BOX 20007 Low/High rate: 7,300/14,600 DEVELOPMENTALLY DISABLED County: WAUSHARA GREENFIELD WI 53220 Initial License: 07/10/2019 EMOTIONALLY DISTURBED/MENTAL PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY PRESTON PLACE CBRF (0014632) PRESTON PLACE INC Type: CBRF HCBS COMPLIANT (920) 566-0790 Class: CNA 401 PRESTON LN ADVANCED AGED REDGRANITE WI 54970 ALLISON O'BRIEN Gender - Capacity: M/F - 20 (920) 566-0270 ALLISON O'BRIEN 401 PRESTON LN Low/High rate: 2,550/4,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUSHARA REDGRANITE WI 54970 Initial License: 06/10/2013 PUBLIC FUNDING ROSEMORE VILLAGE (0018214) COPPERLEAF MANAGEMENT GROUP INC Type: CBRF HCBS COMPLIANT (715) 254-4357 Class: CNA 830 HIGH STREET ADVANCED AGED WILD ROSE WI 54984 KRISTA MENDYKE Gender - Capacity: M/F - 46 (920) 622-4141 JARETT YACH 1077 WILLSHIRE BOULEVARD Low/High rate: 2,550/5,850 DEVELOPMENTALLY DISABLED County: WAUSHARA STEVENS POINT WI 54481 Initial License: 08/05/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 158 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SILVER LAKE HAVEN (0012405) SILVER LAKE MANOR LLC Type: CBRF HCBS COMPLIANT (920) 787-7141 Class: CNA N2641 17TH LANE ADVANCED AGED WAUTOMA WI 54982 RICHARD GOHLKE Gender - Capacity: M/F - 8 (920) 787-7141 JOSIAH GROTHE N2641 17TH LANE Low/High rate: 2,750/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUSHARA WAUTOMA WI 54982 Initial License: 06/03/2008 PHYSICALLY DISABLED TERMINALLY ILL SILVER LAKE MANOR CBRF (0012406) SILVER LAKE MANOR LLC Type: CBRF HCBS COMPLIANT (920) 787-7141 Class: CNA N2641 17TH LANE ADVANCED AGED WAUTOMA WI 54982 RICHARD GOHLKE Gender - Capacity: M/F - 18 (920) 787-7141 JOSIAH GROTHE N2641 17TH LANE Low/High rate: 2,750/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WAUSHARA WAUTOMA WI 54982 Initial License: 07/01/2008 PHYSICALLY DISABLED TERMINALLY ILL TOWNLINE ROAD RESIDENCE (410059) LIVING ENVIRONMENTAL FOUNDATION INC Type: CBRF HCBS COMPLIANT (920) 787-3774 Class: AS 130 S TOWNLINE RD DEVELOPMENTALLY DISABLED WAUTOMA WI 54982 COLLEEN KASUBASKI Gender - Capacity: M/F - 8 (920) 787-3774 COLLEEN KASUBASKI PO BOX 638 Low/High rate: 2,572/2,917 EMOTIONALLY DISTURBED/MENTAL County: WAUSHARA WAUTOMA WI 54982 Initial License: 04/01/1988 ALTEN HAUS TRADITIONS (0013951) ALTEN HAUS LLC Type: CBRF HCBS COMPLIANT (920) 470-9040 Class: CNA 1091 JACOBSEN RD ADVANCED AGED NEENAH WI 54956 ANNE KRAUSE Gender - Capacity: M/F - 15 (920) 470-9040 ANNE ALTENHOFEN KRAUSE 4640 GRAND MEADOWS Low/High rate: 3,500/4,500 DEVELOPMENTALLY DISABLED County: WINNEBAGO APPLETON WI 54914 Initial License: 01/27/2012 IRREVERSIBLE DEMENTIA/ALZHEIM AMERICAN GRAND ASSISTED LIVING SUITES (0016351) AMERICAN GRAND ASSISTED LIVING SUITE INC Type: CBRF ADVANCED AGED (920) 707-3091 Class: CNA 900 MEADOW LN DEVELOPMENTALLY DISABLED NEENAH WI 54956 JEFF ZIOLKOWSKI Gender - Capacity: M/F - 72 (920) 707-3091 CHRISTY MURPHY 130 KUETTEL CT Low/High rate: 3,500/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO NEENAH WI 54956 Initial License: 08/30/2016 TERMINALLY ILL TRAUMATIC BRAIN INJURY ANEW CHOICE CARE INC I (0009557) ANEW CHOICE CARE INC Type: CBRF HCBS COMPLIANT (920) 419-2490 Class: CNA 1255 DEPERE ST ADVANCED AGED MENASHA WI 54952 JASON SCHMITZ Gender - Capacity: M/F - 6 (920) 722-4165 JASON SCHMITZ 1531 ELK TRAIL CT Low/High rate: 5,000/6,000 DEVELOPMENTALLY DISABLED County: WINNEBAGO NEENAH WI 54956 Initial License: 03/15/2002 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY ANEW CHOICE CARE INC II (0009558) ANEW CHOICE CARE INC Type: CBRF HCBS COMPLIANT (920) 419-2490 Class: CNA 1265 DEPERE ST ADVANCED AGED MENASHA WI 54952 JASON SCHMITZ Gender - Capacity: M/F - 6 (920) 722-4275 JASON SCHMITZ 1531 ELK TRAIL CT Low/High rate: 5,000/6,000 DEVELOPMENTALLY DISABLED County: WINNEBAGO NEENAH WI 54956 Initial License: 03/15/2002 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY ARBORVIEW MANOR (410329) GOODLIFE ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (920) 231-7900 Class: CNA 1520 ARBORETUM DR ADVANCED AGED OSHKOSH WI 54901-2790 TIM BURNS Gender - Capacity: M/F - 36 (920) 231-7771 JACOB BURNS PO BOX 851 Low/High rate: 2,700/3,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO OSHKOSH WI 54903-0851 Initial License: 11/15/1992 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY WAIVER CERTIFIED INDEPENDENT C AZURA MEMORY CARE OF OSHKOSH (0013423) AZURA OSHKOSH LLC Type: CBRF HCBS COMPLIANT (720) 838-2901 Class: CNA 2220 BROOKVIEW CT ADVANCED AGED OSHKOSH WI 54904 JILL KREIDER Gender - Capacity: M/F - 18 (920) 426-9900 JUSTINE CHIQUITO 1233 N MAYFAIR RD STE 301 Low/High rate: 5,050/7,050 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO MILWAUKEE WI 53226 Initial License: 08/15/2010

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 159 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

BELLA VISTA (0018670) BELLA VISTA SENIOR CARE LLC Type: CBRF HCBS COMPLIANT (773) 825-3336 Class: CNA 631 HAZEL STREET ADVANCED AGED OSHKOSH WI 54901 MORDY POLSTEIN Gender - Capacity: M/F - 36 (920) 393-9998 MARK HAMLEY 8170 MCCORMICK BLVD 112 Low/High rate: 3,500/4,890 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO SKOKIE IL 60076 Initial License: 08/02/2021 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL BETHEL MENASHA I (0017955) BA ISRAEL LLC Type: CBRF HCBS COMPLIANT (773) 416-8534 Class: CS 1645 CENTURY OAKS COURT ADVANCED AGED MENASHA WI 54952 BRIGHT AMUDOAGHAN Gender - Capacity: M/F - 8 (920) 727-3880 MICHELE PACKETT N9520 SILVER COURT Low/High rate: 5,000/10,000 DEVELOPMENTALLY DISABLED County: WINNEBAGO APPLETON WI 54915 Initial License: 07/22/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BETHEL MENASHA II (0017959) BA ISRAEL LLC Type: CBRF HCBS COMPLIANT (773) 416-8534 Class: CS 1650 CENTURY OAKS COURT ADVANCED AGED MENASHA WI 54952 BRIGHT AMUDOAGHAN Gender - Capacity: M/F - 8 (920) 727-3880 MICHELE PACKETT N9520 SILVER COURT Low/High rate: 5,000/10,000 DEVELOPMENTALLY DISABLED County: WINNEBAGO APPLETON WI 54915 Initial License: 07/22/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BETHEL MENASHA III (0017961) BA ISRAEL LLC Type: CBRF HCBS COMPLIANT (773) 416-8534 Class: CS 1665 CENTURY OAKS COURT ADVANCED AGED MENASHA WI 54952 BRIGHT AMUDOAGHAN Gender - Capacity: M/F - 8 (920) 727-3880 MICHELE PACKETT N9520 SILVER COURT Low/High rate: 5,000/10,000 DEVELOPMENTALLY DISABLED County: WINNEBAGO APPLETON WI 54915 Initial License: 07/22/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY BETHEL MENASHA IV (0017962) BA ISRAEL LLC Type: CBRF HCBS COMPLIANT (773) 416-8534 Class: CS 1670 CENTURY OAKS COURT ADVANCED AGED MENASHA WI 54952 BRIGHT AMUDOAGHAN Gender - Capacity: M/F - 8 (920) 727-3880 MICHELE PACKETT N9520 SILVER COURT Low/High rate: 5,000/10,000 DEVELOPMENTALLY DISABLED County: WINNEBAGO APPLETON WI 54915 Initial License: 07/22/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY CARE PARTNERS WINNECONNE I (0009034) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 234 S 5TH ST ADVANCED AGED WINNECONNE WI 54986 JASON LINDEMANN Gender - Capacity: M/F - 15 (920) 582-4662 ROBYN KARGUS PO BOX 3006 Low/High rate: 1,995/3,645 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54903 Initial License: 09/05/2000 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL CARE PARTNERS WINNECONNE II (0009036) CARE PARTNERS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-1672 Class: CNA 524 GRANT ST ADVANCED AGED WINNECONNE WI 54986 JASON LINDEMANN Gender - Capacity: M/F - 8 (920) 582-7977 HEATH BAYER PO BOX 3006 Low/High rate: 1,945/3,645 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54903 Initial License: 07/01/2000 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 160 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CENTENNIAL INN (0009443) COMMUNITY RETIREMENT LIVING OSHKOSH LL Type: CBRF HCBS COMPLIANT (312) 794-8400 Class: CNA 1628 N MAIN ST ADVANCED AGED OSHKOSH WI 54901 DOUGLAS CAMERON Gender - Capacity: M/F - 18 (920) 236-9360 ELIZABETH FELIX 875 N MICHIGAN AVENUE STE 3740 Low/High rate: 2,831/3,600 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO CHICAGO IL 60611-1916 Initial License: 10/05/2001 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED CLARITY CARE BOWEN STREET HOUSE (410063) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6565 Class: AA 2910 BOWEN ST ADVANCED AGED OSHKOSH WI 54901 BARB SALEMI Gender - Capacity: M/F - 7 (920) 235-1432 KIM HANSEN 424 WASHINGTON AVE Low/High rate: 3,548/3,680 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 06/01/1987 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CLARITY CARE GREENFIELD HOUSE (410332) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 643 GREENFIELD ST ADVANCED AGED NEENAH WI 54956 BARB SALEMI Gender - Capacity: M/F - 8 (920) 469-5240 TRACY ROTH 424 WASHINGTON AVE Low/High rate: 5,132/5,802 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 02/01/1993 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CLARITY CARE JEFFERSON HOUSE (0011509) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 1631 JEFFERSON STREET ADVANCED AGED OSHKOSH WI 54901 BARB SALEMI Gender - Capacity: M/F - 7 (920) 236-6560 KIM HANSEN 424 WASHINGTON AVE Low/High rate: 4,875/6,385 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 06/30/2006 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CLARITY CARE MARICOPA GROUP HOME (410076) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 1380 MARICOPA DR ADVANCED AGED OSHKOSH WI 54904 BARB SALEMI Gender - Capacity: M/F - 6 (920) 233-2031 CODY BOELKE 424 WASHINGTON AVE Low/High rate: 4,154/4,650 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 08/25/1980 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY CLARITY CARE PACKER HEIGHTS (0009823) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 560 W PACKER AVE ADVANCED AGED OSHKOSH WI 54901 BARB SALEMI Gender - Capacity: M/F - 8 (920) 966-1414 KIM HANSEN 424 WASHINGTON AVE Low/High rate: 5,625/11,601 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 10/09/2002 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CLARITY CARE STATE STREET HOUSE (410081) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 105 STATE ST ADVANCED AGED NEENAH WI 54956 BARB SALEMI Gender - Capacity: M - 6 (920) 469-5240 TRACY ROTH 424 WASHINGTON AVE Low/High rate: 4,063/4,245 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 07/18/1980 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 161 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CLARITY CARE THIRD STREET HOUSE (410083) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 225 3RD ST ADVANCED AGED NEENAH WI 54956 BARB SALEMI Gender - Capacity: M/F - 5 (920) 469-5240 TRACY ROTH 424 WASHINGTON AVE Low/High rate: 4,546/5,333 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 06/21/1984 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CLARITY CARE WISCONSIN HEIGHTS (0010727) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 550 W PACKER AVE ADVANCED AGED OSHKOSH WI 54901 BARB SALEMI Gender - Capacity: M/F - 8 (920) 236-6560 KIM HANSEN 424 WASHINGTON AVE Low/High rate: 6,112/6,311 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 11/02/2004 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY CONGRESS (0013750) CLARITY CARE INC Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 1002 CONGRESS AVE ADVANCED AGED OSHKOSH WI 54901 BARB SALEMI Gender - Capacity: M/F - 8 (920) 651-1166 KIM HANSEN 424 WASHINGTON AVE Low/High rate: 4,648/5,341 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54901 Initial License: 09/26/2011 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY CORAL HOUSE (410521) PRODUCTIVE LIVING SYSTEMS INC Type: CBRF HCBS COMPLIANT (715) 831-3910 Class: AA 675 PLANEVIEW DR DEVELOPMENTALLY DISABLED OSHKOSH WI 54904 JENNY MAYVILLE Gender - Capacity: M/F - 8 (920) 688-3760 JENNY MAYVILLE 619 N LYNNDALE DRIVE Low/High rate: 6,006/6,006 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO APPLETON WI 54914 Initial License: 04/13/1998 TRAUMATIC BRAIN INJURY COUNTRY VILLA ASSISTED LIVING (0017149) COUNTRY VILLA ASSISTED LIVING Type: CBRF ADVANCED AGED (920) 213-4437 Class: CNA 1900 HUCKLEBERRY AVE DEVELOPMENTALLY DISABLED OMRO WI 54963 LISA CURTIS Gender - Capacity: M/F - 38 (920) 685-0607 LISA CURTIS 1900 HUCKLEBERRY AVE Low/High rate: 4,100/8,000 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO OMRO WI 54963 Initial License: 06/04/2018 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY COURTYARD AT OSHKOSH (THE) (0017972) OSHKOSH ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (312) 462-4462 Class: CNA 3851 JACKSON STREET ADVANCED AGED OSHKOSH WI 54901 THOMAS OSTROM Gender - Capacity: M/F - 67 (312) 462-4462 SARAH HAMMOND 101 N WACKER DRIVE STE 616 Low/High rate: 3,000/9,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO CHICAGO IL 60606 Initial License: 04/08/2020 PHYSICALLY DISABLED TERMINALLY ILL DIVERSE OPTIONS INC BONNIEVIEW HOME (0008831) DIVERSE OPTIONS INC Type: CBRF HCBS COMPLIANT (920) 748-6387 Class: CNA 6412 BONNIEVIEW RD ADVANCED AGED PICKETT WI 54964 ALLEN SCHRAEDER Gender - Capacity: M/F - 8 (920) 589-5014 REBECCA DERLETH-KUTZ PO BOX 449 571 FENTON ST Low/High rate: 3,527/3,527 DEVELOPMENTALLY DISABLED County: WINNEBAGO RIPON WI 54971-0449 Initial License: 10/15/1999 PHYSICALLY DISABLED EASTBROOKE MANOR ASSISTED LIVING & MEMORY (001 BROOKEVIEW ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-9002 Class: CNA 3504 W 20TH AVENUE ADVANCED AGED OSHKOSH WI 54904 LINDA CARLSON Gender - Capacity: M/F - 25 (920) 232-9002 LINDA CARLSON 3504 W 20TH AVE Low/High rate: 3,027/6,700 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO OSHKOSH WI 54904 Initial License: 06/17/2009 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 162 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

ELDER LODGE (0014449) ELDER LODGE Type: CBRF HCBS COMPLIANT (920) 540-5393 Class: CNA 1055 JACOBSEN RD ADVANCED AGED NEENAH WI 54956 THERESA FROEHLICH Gender - Capacity: M/F - 15 (920) 969-1002 THERESA FROEHLICH 1055 JACOBSEN RD Low/High rate: 3,100/5,500 DEVELOPMENTALLY DISABLED County: WINNEBAGO NEENAH WI 54956 Initial License: 01/28/2013 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL ELIJAHS PLACE (410376) BETHEL HOME INC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM (920) 235-4653 Class: CNA 1551 SOUTHLAND AVE PUBLIC FUNDING OSHKOSH WI 54902 KELLY FITZPATRICK Gender - Capacity: M/F - 12 (920) 235-5599 KELLY FITZPATRICK 225 N EAGLE ST Low/High rate: 6,448/6,448 County: WINNEBAGO OSHKOSH WI 54902 Initial License: 05/16/1994 Association Approval: LeadingAge Wisconsin EVERGREEN SHAREHAVEN HOME (410286) EVERGREEN RETIREMENT COMMUNITY INC Type: CBRF IRREVERSIBLE DEMENTIA/ALZHEIM 1095 N WESTFIELD ST (920) 233-2340 Class: CNA OSHKOSH WI 54902 REBECCA SAVKA Gender - Capacity: M/F - 20 (920) 233-2340 REBECCA SAVKA 1130 N WESTFIELD ST Low/High rate: 7,075/7,874 County: WINNEBAGO OSHKOSH WI 54902 Initial License: 12/04/1991 Association Approval: LeadingAge Wisconsin FRIEDA MAE HAUS (0011681) ALTEN HAUS LLC Type: CBRF HCBS COMPLIANT (920) 730-9596 Class: CNA 625 BONDOW DR ADVANCED AGED NEENAH WI 54956 ANNE ALTENHOFEN KRAUSE Gender - Capacity: M/F - 12 (920) 470-9040 ANNE ALTENHOFEN KRAUSE 4640 GRAND MEADOWS DR Low/High rate: 4,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO APPLETON WI 54914 Initial License: 01/01/2007 GARDEN HEIGHTS CBRF (410151) EVERGREEN RETIREMENT COMMUNITY INC Type: CBRF ADVANCED AGED (920) 237-6220 Class: CNA 1130 N WESTFIELD ST IRREVERSIBLE DEMENTIA/ALZHEIM OSHKOSH WI 54902-3217 STACEY LICHTENSTEIGER Gender - Capacity: M/F - 40 (920) 233-2340 STACEY LICHTENSTEIGER 1130 N WESTFIELD ST Low/High rate: 6,076/7,037 PUBLIC FUNDING County: WINNEBAGO OSHKOSH WI 54902-3217 Initial License: 10/01/1983 Association Approval: LeadingAge Wisconsin GARDENVIEW INC (410396) GARDENVIEW INC Type: CBRF HCBS COMPLIANT (920) 733-4305 Class: CNA 1712 MIDWAY RD ADVANCED AGED MENASHA WI 54952 ANN COYLE Gender - Capacity: M/F - 15 (920) 733-4305 ANN COYLE 1712 MIDWAY RD Low/High rate: 3,100/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO MENASHA WI 54952 Initial License: 10/14/1994 GARDENVIEW INC (410396) GARDENVIEW INC Type: CBRF HCBS COMPLIANT (920) 733-4305 Class: CNA 1712 MIDWAY RD ADVANCED AGED MENASHA WI 54952 ANN COYLE Gender - Capacity: M/F - 15 (920) 733-4305 ANN COYLE 1712 MIDWAY RD Low/High rate: 3,100/4,900 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO MENASHA WI 54952 Initial License: 10/14/1994 Association Approval: LeadingAge Wisconsin GENESIS BEHAVIORAL SERVICES OSHKOSH RES PROG GENESIS BEHAVIORAL SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (414) 255-2938 Class: AA 304 OTTER AVE CORRECTIONAL CLIENTS OSHKOSH WI 54901 PATRICIA FAULHABER Gender - Capacity: M - 14 (414) 255-2938 PATRICIA FAULHABER 6737 W WASHINGTON ST STE 2210 Low/High rate: 3,173/3,173 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO WEST ALLIS WI 53214 Initial License: 09/23/2013 HERITAGE ASSISTED LIVING (410391) THEDACARE Type: CBRF ADVANCED AGED (920) 735-5560 Class: CNA 2600 S HERITAGE WOODS DR IRREVERSIBLE DEMENTIA/ALZHEIM APPLETON WI 54915 KRIS WILSON Gender - Capacity: M/F - 20 (920) 738-3000 KRIS WILSON 2600 S HERITAGE WOODS DR Low/High rate: 4,871/5,311 County: WINNEBAGO APPLETON WI 54915 Initial License: 11/16/1994 Association Approval: LeadingAge Wisconsin JOSEPHINE VERONICA HAUS (0011680) ALTEN HAUS LLC Type: CBRF HCBS COMPLIANT (920) 730-9596 Class: CNA 635 BONDOW DR ADVANCED AGED NEENAH WI 54956 ANNE ALTENHOFEN KRAUSE Gender - Capacity: M/F - 10 (920) 470-9040 ANNE ALTENHOFEN KRAUSE 4640 GRAND MEADOWS DR Low/High rate: 4,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO APPLETON WI 54914 Initial License: 01/01/2007

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 163 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

LAKEPOINT VILLA ASSISTED LIVING (0016733) LAKEPOINT SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 245-3147 Class: CNA 190 LAKE POINTE DRIVE ADVANCED AGED OSHKOSH WI 54904-7858 LEE JOHNSON Gender - Capacity: M/F - 20 (920) 245-3147 TIFFANY MORTH 1675 E RIVERSIDE DR STE 200 Low/High rate: 2,000/3,800 DEVELOPMENTALLY DISABLED County: WINNEBAGO EAGLE ID 83616 Initial License: 06/16/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING Association Approval: WiCAL LAKESHORE MANOR (0018671) LAKESHORE MANOR MEMORY CARE LLC Type: CBRF HCBS COMPLIANT (920) 393-9998 Class: CNA 711 BAYSHORE ROAD ADVANCED AGED OSHKOSH WI 54901 MORDY POLSTEIN Gender - Capacity: M/F - 53 (920) 939-3871 KIM GILES 8170 MCCORMICK BLVD 112 Low/High rate: 3,850/6,800 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO SKOKIE IL 60076 Initial License: 08/02/2021 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY MATTHEWS OF IRISH ROAD CBRF (0014157) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 1760 IRISH RD ADVANCED AGED NEENAH WI 54956 THOMAS OSTROM Gender - Capacity: M/F - 20 (312) 623-0884 STACY RUHL 101 N WACKER DR STE 616 Low/High rate: 3,750/6,107 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL MATTHEWS OF NEENAH I (0014160) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 970 W AMERICAN DR ADVANCED AGED NEENAH WI 54956 THOMAS OSTROM Gender - Capacity: M/F - 16 (920) 886-0491 MELISA ELLINGSON 101 N WACKER DR STE 616 Low/High rate: 4,860/6,572 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL MATTHEWS OF NEENAH II (0014161) MATTHEWS SENIOR HOUSING LLC Type: CBRF HCBS COMPLIANT (312) 623-0884 Class: CNA 990 W AMERICAN DR ADVANCED AGED NEENAH WI 54956 THOMAS OSTROM Gender - Capacity: M/F - 20 (920) 886-3982 MELISA ELLINGSON 101 N WACKER DR STE 616 Low/High rate: 4,860/6,572 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO CHICAGO IL 60606 Initial License: 06/15/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL NOVA COUNSELING SERVICES INC 2 (0010634) NOVA COUNSELING SERVICES INC Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 231-0143 Class: AS 3240 JACKSON ST PUBLIC FUNDING OSHKOSH WI 54901 JODY WILLEFORD Gender - Capacity: M/F - 50 (920) 231-0143 JODY WILLEFORD 3240 JACKSON ST Low/High rate: 4,782/7,000 County: WINNEBAGO OSHKOSH WI 54901 Initial License: 08/31/2004 OAKWOOD MANOR (0011595) GOODLIFE ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (920) 231-7900 Class: CNA 2675 OMRO ROAD ADVANCED AGED OSHKOSH WI 54904 TIMOTHY J BURNS Gender - Capacity: M/F - 22 (920) 235-0779 TIMOTHY J BURNS PO BOX 851 Low/High rate: 6,070/6,670 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO OSHKOSH WI 54903-0851 Initial License: 10/18/2006 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY WAIVER CERTIFIED INDEPENDENT C PARKSIDE SENIOR LIVING (0016732) BRUCE NEENAH SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (920) 727-1120 Class: CNA 2330 BRUCE STREET ADVANCED AGED NEENAH WI 54956-4834 LEE JOHNSON Gender - Capacity: M/F - 20 (920) 245-3132 TIFFANY MORTH 1675 E RIVERSIDE DR STE 150 Low/High rate: 2,000/3,800 DEVELOPMENTALLY DISABLED County: WINNEBAGO EAGLE ID 83616 Initial License: 08/01/2017 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING Association Approval: WiCAL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 164 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

PNUMA 1 (0017023) PNUMA LLC Type: CBRF DEVELOPMENTALLY DISABLED (715) 831-3910 Class: AA W7066 WINNEGAMIE DR EMOTIONALLY DISTURBED/MENTAL APPLETON WI 54914 NATALIE MOSEY Gender - Capacity: M/F - 5 (920) 470-6983 JOHN ERCK 2411 N HILLCREST PKWY STE 6 Low/High rate: 3,717/3,717 County: WINNEBAGO ALTOONA WI 54720 Initial License: 03/28/2018 PNUMA 2 (0017022) PNUMA LLC Type: CBRF DEVELOPMENTALLY DISABLED (715) 831-3910 Class: AA 233 S LYNNDALE DR EMOTIONALLY DISTURBED/MENTAL APPLETON WI 54914 NATALIE MOSEY Gender - Capacity: M/F - 5 (920) 470-6983 JOHN ERCK 2411 N HILLCREST PKWY STE 6 Low/High rate: 4,358/4,358 County: WINNEBAGO ALTOONA WI 54720 Initial License: 03/28/2018 PNUMA 3 (0017021) PNUMA LLC Type: CBRF DEVELOPMENTALLY DISABLED (715) 831-3910 Class: AA 1955 COUNTY TRUNK A EMOTIONALLY DISTURBED/MENTAL NEENAH WI 54956 NATALIE MOSEY Gender - Capacity: M/F - 6 (920) 470-6983 JOHN ERCK 2411 N HILLCREST PKWY STE 6 Low/High rate: 4,251/4,251 County: WINNEBAGO ALTOONA WI 54720 Initial License: 03/28/2018 PRAIRIE HOME I (0013018) PRAIRIE HOME ELDER SERVICES LLC Type: CBRF ADVANCED AGED (920) 969-0526 Class: CNA 1463 KENWOOD DR DEVELOPMENTALLY DISABLED MENASHA WI 54952 JOHN MC CARTHY Gender - Capacity: M/F - 20 (920) 969-0526 TANYA NEUBERT 1463 KENWOOD DR Low/High rate: 5,300/6,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO MENASHA WI 54952 Initial License: 10/01/2009 PHYSICALLY DISABLED TERMINALLY ILL TRAUMATIC BRAIN INJURY PRAIRIE HOME II (0009115) PRAIRIE HOME ELDER SERVICES LLC Type: CBRF ADVANCED AGED (920) 969-0526 Class: CNA 1461 KENWOOD DR IRREVERSIBLE DEMENTIA/ALZHEIM MENASHA WI 54952 MICHAEL MC CARTHY Gender - Capacity: M/F - 15 (920) 886-0524 TANYA NEUBERT 1463 KENWOOD DR Low/High rate: 5,300/6,600 PHYSICALLY DISABLED County: WINNEBAGO MENASHA WI 54952 Initial License: 12/07/2000 TERMINALLY ILL PRAIRIE HOME III (410552) PRAIRIE HOME ELDER SERVICES LLC Type: CBRF ADVANCED AGED (920) 969-0526 Class: CNA 1459 KENWOOD DR IRREVERSIBLE DEMENTIA/ALZHEIM MENASHA WI 54952 JOHN MC CARTHY Gender - Capacity: M/F - 18 (920) 886-0538 TANYA NEUBERT 1463 KENWOOD DR Low/High rate: 4,200/6,450 PHYSICALLY DISABLED County: WINNEBAGO MENASHA WI 54952 Initial License: 01/05/1999 TERMINALLY ILL REHABILITATION HOUSE INC (410111) REHABILITATION HOUSE INC Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 725-2271 Class: AS 107 PROFESSIONAL PLAZA CORRECTIONAL CLIENTS NEENAH WI 54956 SCOTT PEEPLES Gender - Capacity: M/F - 14 (920) 725-2271 SCOTT PEEPLES 107 PROFESSIONAL PLAZA Low/High rate: 2,449/4,030 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO NEENAH WI 54956 Initial License: 05/14/1981 PUBLIC FUNDING RESIDENCE AT OSHKOSH I (THE) (0018410) OSHKOSH WI AL LLC Type: CBRF ADVANCED AGED (646) 844-3603 Class: CNA 1018 WEST MURDOCH AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM OSHKOSH WI 54901 LISA GELHAR Gender - Capacity: M/F - 34 (920) 385-0570 LISA GELHAR 1018 WEST MURDOCH AVENUE Low/High rate: 3,000/4,000 PUBLIC FUNDING County: WINNEBAGO OSHKOSH WI 54901 Initial License: 05/01/2021 TERMINALLY ILL RESIDENCE AT OSHKOSH II (THE) (0018411) OSHKOSH WI AL LLC Type: CBRF ADVANCED AGED (646) 844-3603 Class: CNA 1110 WEST MURDOCK AVENUE IRREVERSIBLE DEMENTIA/ALZHEIM OSHKOSH WI 54901 LISA GELHAR Gender - Capacity: M/F - 32 (920) 385-0570 LISA GELHAR 1110 WEST MURDOCK AVENUE Low/High rate: 3,000/4,000 PUBLIC FUNDING County: WINNEBAGO OSHKOSH WI 54901 Initial License: 05/01/2021 TERMINALLY ILL RESIDENCE AT OSHKOSH III (THE) (0018412) OSHKOSH WI AL LLC Type: CBRF ADVANCED AGED (646) 844-3603 Class: CNA 1816 VINLAND STREET IRREVERSIBLE DEMENTIA/ALZHEIM OSHKOSH WI 54901 LISA GELHAR Gender - Capacity: M/F - 43 (920) 385-0570 LISA GELHAR 1816 VINLAND STREET Low/High rate: 3,000/4,000 PUBLIC FUNDING County: WINNEBAGO OSHKOSH WI 54901 Initial License: 05/01/2021 TERMINALLY ILL SERENITY PLACE I (0009570) SERENITY PLACE INC Type: CBRF HCBS COMPLIANT (920) 427-9047 Class: CS 1538 W SIXTH AVE ADVANCED AGED OSHKOSH WI 54902 DIANE HOLLUB Gender - Capacity: M/F - 7 (920) 233-8942 DIANE HOLLUB 8405 STEEPLE HILL DR Low/High rate: 2,979/3,298 DEVELOPMENTALLY DISABLED County: WINNEBAGO LARSEN WI 54947 Initial License: 02/22/2002 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 165 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

SERENITY PLACE II (0009571) SERENITY PLACE INC Type: CBRF HCBS COMPLIANT (920) 427-9047 Class: AA 19 E LINCOLN AVE DEVELOPMENTALLY DISABLED OSHKOSH WI 54901 DIANE HOLLUB Gender - Capacity: M/F - 5 (920) 233-8991 DIANE HOLLUB 8405 STEEPLE HILL DR Low/High rate: 2,969/4,069 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO LARSEN WI 54907 Initial License: 02/22/2002 IRREVERSIBLE DEMENTIA/ALZHEIM PUBLIC FUNDING VISTA CARE ALLERTON (0015066) VISTA CARE WISCONSIN INC Type: CBRF HCBS COMPLIANT (920) 694-1104 Class: CNA 1657 MARICOPA DR DEVELOPMENTALLY DISABLED OSHKOSH WI 54904 ROBERT BACHICHA Gender - Capacity: M/F - 8 (920) 694-1170 ROBERT BACHICHA 708 ERIE AVE STE 201 Low/High rate: 5,232/5,232 EMOTIONALLY DISTURBED/MENTAL County: WINNEBAGO SHEBOYGAN WI 53081 Initial License: 06/16/2014 PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY VNA ASSISTED LIVING (410559) VALLEY VNA ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (920) 727-5544 Class: CNA 1533 LYON DR ADVANCED AGED NEENAH WI 54956 ANGELA FRANZ Gender - Capacity: M/F - 64 (920) 727-5544 ANGELA FRANZ 1533 LYON DR Low/High rate: 4,961/8,515 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO NEENAH WI 54956 Initial License: 07/23/1998 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: WALA WEBSTER MANOR (410448) GOODLIFE ASSISTED LIVING INC Type: CBRF HCBS COMPLIANT (920) 231-7900 Class: CNA 515 S WEBSTER AVE ADVANCED AGED OMRO WI 54963 TIM BURNS Gender - Capacity: M/F - 20 (920) 685-5776 JACOB BURNS PO BOX 851 Low/High rate: 4,005/4,805 DEVELOPMENTALLY DISABLED County: WINNEBAGO OSHKOSH WI 54903-0851 Initial License: 08/16/1996 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL WAIVER CERTIFIED INDEPENDENT C WESTBROOKE MANOR ASSISTED LIVING & MEMORY CA BROOKEVIEW ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (920) 232-9920 Class: CNA 3508 W 20TH AVE ADVANCED AGED OSHKOSH WI 54904 LINDA C CARLSON Gender - Capacity: M/F - 25 (920) 232-9920 LINDA C CARLSON 3504 W 20TH AVE Low/High rate: 3,127/6,400 IRREVERSIBLE DEMENTIA/ALZHEIM County: WINNEBAGO OSHKOSH WI 54904 Initial License: 11/28/2011 PUBLIC FUNDING WINNEBAGO COUNTY CRISIS CENTER (0018021) WINNEBAGO COUNTY DHS Type: CBRF ALCOHOL/DRUG DEPENDENT (920) 236-4700 Class: AS 684 BUTLER AVENUE EMOTIONALLY DISTURBED/MENTAL OSHKOSH WI 54901 JOHN SHEEHAN Gender - Capacity: M/F - 16 (920) 233-7707 JOHN SHEEHAN 220 WASHINGTON AVENUE Low/High rate: County: WINNEBAGO OSHKOSH WI 54901 Initial License: 03/27/2020 A TOUCH OF HOME 1 (0015266) T & C ADULT HOMES Type: CBRF HCBS COMPLIANT (715) 316-2716 Class: CNA 9787 W IVES ST ADVANCED AGED MARSHFIELD WI 54449 TOM SHILTS Gender - Capacity: M/F - 8 (715) 387-2080 HANNAH WESTLUND M225 TURTLE RIDGE RD Low/High rate: 2,800/3,600 DEVELOPMENTALLY DISABLED County: WOOD MARSHFIELD WI 54449 Initial License: 10/06/2014 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL A TOUCH OF HOME 2 (0013696) T & C ADULT HOMES Type: CBRF HCBS COMPLIANT (715) 387-2080 Class: CNA 720 S CYPRESS AVE ADVANCED AGED MARSHFIELD WI 54449 CATHIE SHILTS Gender - Capacity: M/F - 8 (715) 384-4851 HANNAH WESTLUND M225 TURTLE RIDGE RD Low/High rate: 2,900/3,900 DEVELOPMENTALLY DISABLED County: WOOD MARSHFIELD WI 54449 Initial License: 08/22/2011 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 166 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

A TOUCH OF HOME 3 (0014266) T & C ADULT HOMES Type: CBRF HCBS COMPLIANT (715) 387-2080 Class: CNA 612 E 25TH ST ADVANCED AGED MARSHFIELD WI 54449 HANNAH WESTLUND Gender - Capacity: M/F - 8 (715) 207-0153 HANNAH WESTLUND 204409 HIDDEN ACRES LANE Low/High rate: 2,800/4,000 DEVELOPMENTALLY DISABLED County: WOOD MARSHFIELD WI 54449 Initial License: 07/11/2012 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL ADAMS AVENUE GROUP HOME (0013144) CLARITY CARE Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 613 W 11TH ST ADVANCED AGED MARSHFIELD WI 54449 BARB SALEMI Gender - Capacity: M/F - 6 (715) 389-2720 KIM HANSEN 424 WASHINGTON AVE Low/High rate: 4,830/7,172 DEVELOPMENTALLY DISABLED County: WOOD OSHKOSH WI 54901 Initial License: 01/01/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY ALICE & LOUISES II (0017158) ALICE & LOUISES II Type: CBRF HCBS COMPLIANT (715) 897-2666 Class: CNA 8679 STATE HWY 186 ADVANCED AGED ARPIN WI 54410 ALICEN BRODHAGEN BUNDICK Gender - Capacity: M/F - 8 ALICEN BRODHAGEN BUNDICK 8128 STATE HWY 80 Low/High rate: 3,650/4,200 DEVELOPMENTALLY DISABLED County: WOOD MARSHFIELD WI 54449 Initial License: 02/26/2020 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL APPLE AVENUE GROUP HOME (0013143) CLARITY CARE Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 1406 S APPLE AVE ADVANCED AGED MARSHFIELD WI 54449 BARB SALEMI Gender - Capacity: M/F - 6 (715) 486-8421 KIM HANSEN 424 WASHINGTON AVE Low/High rate: 4,474/6,868 DEVELOPMENTALLY DISABLED County: WOOD OSHKOSH WI 54901 Initial License: 01/01/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY ARBORVIEW COURT (0013373) CRYSTAL FOUNTAINS ASSISTED LIVING LLC Type: CBRF HCBS COMPLIANT (715) 342-9100 Class: CNA 3750 BLUE VIOLET LN ADVANCED AGED WISCONSIN RAPIDS WI 54494 KAREN TRZEBIATOWSKI Gender - Capacity: M/F - 54 (715) 424-3758 KAREN TRZEBIATOWSKI 3450 BRIDLEWOOD DR Low/High rate: 3,500/4,500 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD PLOVER WI 54467 Initial License: 10/27/2010 PUBLIC FUNDING BRIDGEWAY (0016560) WOOD COUNTY HUMAN SERVICES Type: CBRF EMOTIONALLY DISTURBED/MENTAL 1600 N CHESTNUT AVE (715) 421-8881 Class: CS MARSHFIELD WI 54449 KATIE CZYS Gender - Capacity: M/F - 8 (715) 421-8881 KATIE CZYS 1600 N CHESTNUT ST Low/High rate: 30/15,056 County: WOOD MARSHFIELD WI 54449 Initial License: 02/15/2017 CRANBERRY COURT ASSISTED LIVING I (0015632) WISCONSIN RAPIDS SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (715) 421-2121 Class: CNA 2230 14TH ST SOUTH ADVANCED AGED WISCONSIN RAPIDS WI 54494 LEE JOHNSON Gender - Capacity: M/F - 20 (715) 421-2121 CRYSTAL STOVER 2230 14TH ST SOUTH Low/High rate: 2,219/3,727 DEVELOPMENTALLY DISABLED County: WOOD WISCONSIN RAPIDS WI 54494 Initial License: 08/01/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: WiCAL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 167 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

CRANBERRY COURT ASSISTED LIVING II (0015631) WISCONSIN RAPIDS SENIOR LIVING INC Type: CBRF HCBS COMPLIANT (715) 421-2121 Class: CNA 2230 JAMES CT ADVANCED AGED WISCONSIN RAPIDS WI 54494 LEE JOHNSON Gender - Capacity: M/F - 22 (715) 421-2121 CRYSTAL STOVER 2230 JAMES CT Low/High rate: 2,219/3,727 DEVELOPMENTALLY DISABLED County: WOOD WISCONSIN RAPIDS WI 54494 Initial License: 08/01/2015 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL DELANEY HOME LLC (0011989) TIMOTHY&MELISSA DELANEY Type: CBRF HCBS COMPLIANT (715) 884-2782 Class: CS 5342 3RD AVENUE ADVANCED AGED PITTSVILLE WI 54466 TIMOTHY DELANEY Gender - Capacity: M/F - 10 (715) 884-2782 TIMOTHY DELANEY PO BOX E Low/High rate: 2,400/3,600 DEVELOPMENTALLY DISABLED County: WOOD PITTSVILLE WI 54466 Initial License: 07/06/2007 PUBLIC FUNDING DRAKE HOUSE I (THE) (0017385) DRAKE HOUSE OF MARSHFIELD LLC Type: CBRF HCBS COMPLIANT (715) 252-9720 Class: CNA 800 S DRAKE AVE DEVELOPMENTALLY DISABLED MARSHFIELD WI 54449 ELIZABETH LEMOINE Gender - Capacity: M/F - 8 (715) 389-9902 ELIZABETH LEMOINE 517 MAGEE ST Low/High rate: 3,000/4,500 EMOTIONALLY DISTURBED/MENTAL County: WOOD MARSHFIELD WI 54449 Initial License: 02/25/2019 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED DRAKE HOUSE II (THE) (0017386) DRAKE COMMUNITY SERVICES II Type: CBRF DEVELOPMENTALLY DISABLED (715) 305-3524 Class: CNA 212 COLUMBUS DR EMOTIONALLY DISTURBED/MENTAL MARSHFIELD WI 54449 JILL KORAN Gender - Capacity: M/F - 8 (715) 389-1200 JILL KORAN 10516 BEAR LN Low/High rate: 2,100/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD MARSHFIELD WI 54449 Initial License: 03/26/2019 PHYSICALLY DISABLED PUBLIC FUNDING DRAKE HOUSE III (THE) (0017407) DRAKE COMMUNITY SERVICES II Type: CBRF HCBS COMPLIANT (715) 305-3524 Class: AA 501 W 13TH ST DEVELOPMENTALLY DISABLED MARSHFIELD WI 54449 JILL KORAN Gender - Capacity: M - 8 (715) 384-9022 JILL KORAN 10516 BEAR LN Low/High rate: 2,600/5,000 EMOTIONALLY DISTURBED/MENTAL County: WOOD MARSHFIELD WI 54449 Initial License: 06/10/2019 PUBLIC FUNDING ELMWOOD INN (0016242) BROWNS LIVING LLC Type: CBRF HCBS COMPLIANT (715) 650-3304 Class: AA 521 ELM ST ALCOHOL/DRUG DEPENDENT WISCONSIN RAPIDS WI 54494 DAVID THEWES JR Gender - Capacity: M/F - 8 (715) 421-2244 DAVID THEWES JR 252 S CENTRAL AVE STE 21 Low/High rate: 9,725/15,600 DEVELOPMENTALLY DISABLED County: WOOD MARSHFIELD WI 54449 Initial License: 08/24/2016 EMOTIONALLY DISTURBED/MENTAL TRAUMATIC BRAIN INJURY HILLTOP ASSISTED LIVING ALPINE TERRACE (0014168) HILLTOP AFFILIATES INC Type: CBRF HCBS COMPLIANT (715) 423-7400 Class: CNA 1610 25TH AVE SOUTH ADVANCED AGED WISCONSIN RAPIDS WI 54494 ANITA WHETSTONE Gender - Capacity: M/F - 12 (715) 423-1610 ANITA WHETSTONE 1400 24TH ST. SOUTH Low/High rate: 2,975/6,000 DEVELOPMENTALLY DISABLED County: WOOD WISCONSIN RAPIDS WI 54494 Initial License: 04/24/2012 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY HILLTOP ESTATES (0012662) HILLTOP AFFILIATES INC Type: CBRF HCBS COMPLIANT (715) 423-7400 Class: AA 914 STATE HWY 73 SOUTH DEVELOPMENTALLY DISABLED WISCONSIN RAPIDS WI 54494 ANITA WHETSTONE Gender - Capacity: M/F - 6 (715) 423-7400 ANITA WHETSTONE 1400 24th STREET SOUTH Low/High rate: 3,500/6,500 EMOTIONALLY DISTURBED/MENTAL County: WOOD WISCONSIN RAPIDS WI 54494 Initial License: 04/01/2009 PHYSICALLY DISABLED TRAUMATIC BRAIN INJURY HILLTOP OF PEPPER (0010105) HILLTOP AFFILIATES INC Type: CBRF HCBS COMPLIANT (715) 423-7400 Class: CNA 630 PEPPER AVENUE ADVANCED AGED WISCONSIN RAPIDS WI 54494 ANITA WHETSTONE Gender - Capacity: M/F - 21 (715) 423-7400 ANITA WHETSTONE 630 PEPPER AVENUE Low/High rate: 2,975/8,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD WISCONSIN RAPIDS WI 54494 Initial License: 08/12/2003 OUR HOUSE WI RAPIDS ASSISTED CARE (0013445) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 2941 16TH ST SOUTH ADVANCED AGED WISCONSIN RAPIDS WI 54494 LORI NARDIN Gender - Capacity: M/F - 20 (715) 421-3060 TAMMY LUKOMSKI 4350 156th ST Low/High rate: 3,675/3,675 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 168 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

OUR HOUSE WI RAPIDS MEMORY CARE (0013444) KSMS OUR HOUSE LLC Type: CBRF HCBS COMPLIANT (317) 280-8455 Class: CNA 2711 12TH ST SOUTH ADVANCED AGED WISCONSIN RAPIDS WI 54494 LORI NARDIN Gender - Capacity: M/F - 20 (715) 423-1700 PAMELA PAVEK 4350 156TH ST Low/High rate: 3,875/4,375 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD CHIPPEWA FALLS WI 54729 Initial License: 09/30/2010 PUBLIC FUNDING PEACH AVENUE GROUP HOME (0013145) CLARITY CARE Type: CBRF HCBS COMPLIANT (920) 236-6560 Class: CNA 2401 S PEACH AVE ADVANCED AGED MARSHFIELD WI 54449 BARB SALEMI Gender - Capacity: M/F - 6 (715) 389-2854 KIM HANSEN 424 WASHINGTON AVE Low/High rate: 5,651/6,473 DEVELOPMENTALLY DISABLED County: WOOD OSHKOSH WI 54901 Initial License: 01/01/2010 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TRAUMATIC BRAIN INJURY SAFE HAVEN SENIOR CARE LLC (0017226) SAFE HAVEN SENIOR CARE LLC Type: CBRF HCBS COMPLIANT (715) 898-1731 Class: CNA 414 E 19TH ST ADVANCED AGED MARSHFIELD WI 54449 SHANNON SCHNITZLER Gender - Capacity: M/F - 8 (715) 898-1731 SHANNON SCHNITZLER 414 E 19TH ST Low/High rate: 0/3,500 DEVELOPMENTALLY DISABLED County: WOOD MARSHFIELD WI 54449 Initial License: 03/13/2019 EMOTIONALLY DISTURBED/MENTAL IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL TRAUMATIC BRAIN INJURY Association Approval: WALA SERENITY LIVING LLC (0017276) SERENITY LIVING LLC Type: CBRF ADVANCED AGED (715) 650-7191 Class: CNA 1301 E DOEGE ST DEVELOPMENTALLY DISABLED MARSHFIELD WI 54449 HANNAH WESTLUND Gender - Capacity: M/F - 8 (715) 207-0224 HANNAH WESTLUND M 328 FOX AVE Low/High rate: 3,600/3,600 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD MARSHFIELD WI 54449 Initial License: 10/03/2018 STONEY RIVER ASSISTED LIVING (0014626) SABRA PHOENIX MARSHFIELD LLC Type: CBRF HCBS COMPLIANT (949) 679-0251 Class: CNA 1204 W MCMILLAN ST ADVANCED AGED MARSHFIELD WI 54449 SARAH KRENN Gender - Capacity: M/F - 60 (715) 207-6423 SARAH KRENN 1204 W MCMILLAN ST Low/High rate: 4,246/7,046 EMOTIONALLY DISTURBED/MENTAL County: WOOD MARSHFIELD WI 54449 Initial License: 06/25/2013 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED TERMINALLY ILL Association Approval: WALA STONEY RIVER MEMORY CARE (0017202) SABRA MARSHFIELD II TRS LLC Type: CBRF ADVANCED AGED (949) 679-0251 Class: CNA 1606 N ST JOSEPH AVE DEVELOPMENTALLY DISABLED MARSHFIELD WI 54449 SARAH KRENN Gender - Capacity: M/F - 32 (715) 384-7007 SARAH KRENN 1606 N ST JOSEPH AVE Low/High rate: 5,665/6,665 EMOTIONALLY DISTURBED/MENTAL County: WOOD MARSHFIELD WI 54449 Initial License: 11/01/2018 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL Association Approval: WALA WATERFORD AT WISCONSIN RAPIDS (THE) (0015957) CSL WISCONSIN RAPIDS LLC Type: CBRF HCBS COMPLIANT (972) 308-8387 Class: CNA 491 25TH ST N ADVANCED AGED WISCONSIN RAPIDS WI 54494 KRISTEN HUTCHISON Gender - Capacity: M/F - 48 (715) 421-0045 KIRSTEN HUTCHISON 1740 CONDOR LANE Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD GREEN BAY WI 54313 Initial License: 01/26/2016 PHYSICALLY DISABLED TERMINALLY ILL WATERFORD AT WISCONSIN RAPIDS MEMORY CARE (TH CSL WISCONSIN RAPIDS LLC Type: CBRF HCBS COMPLIANT (972) 308-8387 Class: CNA 2440 BAKER ST ADVANCED AGED WISCONSIN RAPIDS WI 54494 KRISTEN HUTCHISON Gender - Capacity: M/F - 18 (715) 421-0045 KIRSTEN HUTCHISON 1740 CONDOR LANE Low/High rate: 3,000/5,000 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD GREEN BAY WI 54494 Initial License: 01/26/2016 PHYSICALLY DISABLED TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly. Wisconsin Department Division of Quality Assurance Directory 08/30/2021 of Health Services UdtdPage 169 Public Directory By County, Facility Name For Facility Type CBRF

Facility Name and Address Licensee Name and Phone Phone Number / Contact Person Mailing Address Specialty Programs

WELLINGTON PLACE AT BIRON (0017439) WISCONSIN ILLINOIS SENIOR HOUSING INC Type: CBRF HCBS COMPLIANT (303) 980-0611 Class: CNA 1661 BIRON DR ADVANCED AGED WISCONSIN RAPIDS WI 54494 MANDY SCHULIST Gender - Capacity: M/F - 30 (715) 423-5600 MANDY SCHULIST 1661 BIRON DR Low/High rate: 2,721/5,726 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD WISCONSIN RAPIDS WI 54494 Initial License: 03/05/2020 PHYSICALLY DISABLED WELLS NATURE VIEW I (610269) WELLS NATURE VIEW INC Type: CBRF HCBS COMPLIANT (715) 384-7615 Class: CNA 1016 SOUTH ADAMS AVENUE ADVANCED AGED MARSHFIELD WI 54449 JAMES WELLS Gender - Capacity: M/F - 20 (715) 384-7615 JAMES WELLS 1016 SOUTH ADAMS AVENUE Low/High rate: 4,200/4,200 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD MARSHFIELD WI 54449 Initial License: 02/23/1996 PUBLIC FUNDING TERMINALLY ILL WELLS NATURE VIEW II (611047) WELLS NATURE VIEW SENIOR CITIZENS HOMES Type: CBRF HCBS COMPLIANT (715) 387-1756 Class: CNA 601 EAST 21ST STREET ADVANCED AGED MARSHFIELD WI 54449 RONALD WELLS Gender - Capacity: M/F - 20 (715) 387-1756 RONALD WELLS 601 EAST 21ST STREET Low/High rate: 4,300/4,100 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD MARSHFIELD WI 54449 Initial License: 10/10/1997 PUBLIC FUNDING WELLS NATURE VIEW III (0009393) WELLS NATURE VIEW SENIOR CITIZENS ASST L Type: CBRF HCBS COMPLIANT (715) 384-7615 Class: CNA 2711 SOUTH APPLE AVENUE ADVANCED AGED MARSHFIELD WI 54449 RON WELLS Gender - Capacity: M/F - 20 (715) 384-7882 RON WELLS 2711 SOUTH APPLE AVENUE Low/High rate: 4,200/4,200 EMOTIONALLY DISTURBED/MENTAL County: WOOD MARSHFIELD WI 54449 Initial License: 12/06/2001 IRREVERSIBLE DEMENTIA/ALZHEIM PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL WELLS NATURE VIEW IV (0014746) WELLS NATURE VIEW SENIOR CITIZEN ASSISTE Type: CBRF HCBS COMPLIANT (715) 384-7515 Class: CNA 2807 S APPLE AVE ADVANCED AGED MARSHFIELD WI 54449 RONALD WELLS Gender - Capacity: M/F - 20 (715) 305-2057 RONALD WELLS 601 E 21 ST Low/High rate: 4,300/4,300 IRREVERSIBLE DEMENTIA/ALZHEIM County: WOOD MARSHFIELD WI 54449 Initial License: 08/12/2013 PHYSICALLY DISABLED PUBLIC FUNDING TERMINALLY ILL

*The Community Based Residential Facility (CBRF) directory is updated monthly.