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External Provider - Add/Remove Staff - Absorb LMS
External Provider - Add/Remove Staff - Absorb LMS
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First Name
Last Name
Email
Provider/Agency Name
ABA Pathways, LLC
Acorn Health of Michigan, LLC
Agnes Rambo – HNNP (ACL)
APS Employment, Inc.
Autism of America, LLC
Autism Systems, LLC
Bay Human Services, Inc.
Beacon Harbor of Saginaw Home #1 – Beacon Harbor Homes
Beacon Harbor of Saginaw Home #2 – Beacon Harbor Homes
Beacon Harbor of Saginaw Home #3 – Beacon Harbor Homes
Beacon Harbor of Saginaw Home #4 – Beacon Harbor Homes
Beacon Harbor of Saginaw Home #5 – Beacon Harbor Homes
Beacon Harbor of Saginaw Sandra Court Home – Beacon Harbor Homes
Cambridge AFC – Bay Human Services
Cardinal Care AFC – Independent Living Solutions
Case Management of Michigan
Child and Family Services
Children’s Therapy Corner
DCO – SPS – SUD – Outpatient
Flourish Services LLC
Forest St. – Wellspring Lutheran Services
Game Changers Pediatric Therapy Services, LLC
Geddes Rd. AFC – Central State Community Services
Genoa
Gera Rd. AFC – VRSI
Glenvale AFC – Bay Human Services
Grounded Therapy Network
GT Independence (GuardianTrac)
Guided Grace
HealthSource
Helping Others Means Everything – HOME, LLC
HNNP – Hope Network New Passages (ACL)
HNPP - Adult Case Management
House of Hope AFC – Bay Human Services
JubeJu Co, Inc.
Kneaded Angels Adult Living Home II – Kneaded Angels
Kneaded Angels Adult Living Home III – Kneaded Angels
Kneaded Angels Adult Living Home IV – Kneaded Angels
Kneaded Angels Adult Living Home V – Kneaded Angels
Kneaded Angels, Inc.
Liberty AFC – VRSI
Lutheran Supported Living Home (Bethesda AFC) – Wellspring Lutheran
McCall Cottages
McDowell
Mercy Plus Healthcare
MyMichigan Saginaw Guardian Angels – Davis & Howard Locations
Navaho Trail AFC – VRSI
Other
Paramount
Reis AFC
ResCare Premier – Center Woods
ResCare Premier - Lawndale
ResCare Premier – McCarty
ResCare Premier – Vienna
ResCare Premier - Winfield
ResCare Premier, Inc.
Riverfront AFC – Resident Advancement
Roseview AFC – VRSI
Saginaw Meadows CRU – HNNP (ACL)
Saginaw Valley AFC – Independent Living Solutions
Saint Charles AFC – VRSI
Slatestone BHC - Bay Human Services
Sloan Rd. AFC – Central State Community Services
Southport AFC – VRSI
Spectrum Autism Center
SPS Adult Case Management
SPS Children’s Outpatient & Case Management
Stuart Wilson
Sunnyside Assisted Living Home – Caleb
SVRC Empowered Voices
The Prosperity House (AFC)
Together with Friends – Wellspring Lutheran Services
Tony Krasinski AFC
TTI Adult Case Management
TTI Assertive Community Treatment (ACT)
TTI Bayside Clubhouse
TTI Friends for Recovery Drop-In Center
Valley Residential Services, Inc. (VRSI)
Weiss St. AFC – HNNP (ACL)
Wellspring Lutheran Services – Lutheran Child & Family
Westlund Guidance Clinic
Woodlawn AFC – Resident Advancement
Provider/Agency Name - Other
Provider/Agency Name
ABA Pathways, LLC
Acorn Health of Michigan, LLC
Agnes Rambo – HNNP (ACL)
APS Employment, Inc.
Autism of America, LLC
Autism Systems, LLC
Bay Human Services, Inc.
Beacon Harbor of Saginaw Home #1 – Beacon Harbor Homes
Beacon Harbor of Saginaw Home #2 – Beacon Harbor Homes
Beacon Harbor of Saginaw Home #3 – Beacon Harbor Homes
Beacon Harbor of Saginaw Home #4 – Beacon Harbor Homes
Beacon Harbor of Saginaw Home #5 – Beacon Harbor Homes
Beacon Harbor of Saginaw Sandra Court Home – Beacon Harbor Homes
Cambridge AFC – Bay Human Services
Cardinal Care AFC – Independent Living Solutions
Case Management of Michigan
Child and Family Services
Children’s Therapy Corner
DCO – SPS – SUD – Outpatient
Flourish Services LLC
Forest St. – Wellspring Lutheran Services
Game Changers Pediatric Therapy Services, LLC
Geddes Rd. AFC – Central State Community Services
Genoa
Gera Rd. AFC – VRSI
Glenvale AFC – Bay Human Services
Grounded Therapy Network
GT Independence (GuardianTrac)
Guided Grace
HealthSource
Helping Others Means Everything – HOME, LLC
HNNP – Hope Network New Passages (ACL)
HNPP - Adult Case Management
House of Hope AFC – Bay Human Services
JubeJu Co, Inc.
Kneaded Angels Adult Living Home II – Kneaded Angels
Kneaded Angels Adult Living Home III – Kneaded Angels
Kneaded Angels Adult Living Home IV – Kneaded Angels
Kneaded Angels Adult Living Home V – Kneaded Angels
Kneaded Angels, Inc.
Liberty AFC – VRSI
Lutheran Supported Living Home (Bethesda AFC) – Wellspring Lutheran
McCall Cottages
McDowell
Mercy Plus Healthcare
MyMichigan Saginaw Guardian Angels – Davis & Howard Locations
Navaho Trail AFC – VRSI
Other
Paramount
Regency Assisted Living, LLC
Reis AFC
ResCare Premier – Center Woods
ResCare Premier - Lawndale
ResCare Premier – McCarty
ResCare Premier – Vienna
ResCare Premier - Winfield
ResCare Premier, Inc.
Riverfront AFC – Resident Advancement
Roseview AFC – VRSI
Saginaw Meadows CRU – HNNP (ACL)
Saginaw Valley AFC – Independent Living Solutions
Saint Charles AFC – VRSI
Slatestone BHC - Bay Human Services
Sloan Rd. AFC – Central State Community Services
Southport AFC – VRSI
Spectrum Autism Center
SPS Adult Case Management
SPS Children’s Outpatient & Case Management
Stuart Wilson
Sunnyside Assisted Living Home – Caleb
SVRC Empowered Voices
The Prosperity House (AFC)
Together with Friends – Wellspring Lutheran Services
Tony Krasinski AFC
TTI Adult Case Management
TTI Assertive Community Treatment (ACT)
TTI Bayside Clubhouse
TTI Friends for Recovery Drop-In Center
Valley Residential Services, Inc. (VRSI)
Weiss St. AFC – HNNP (ACL)
Wellspring Lutheran Services – Lutheran Child & Family
Westlund Guidance Clinic
Woodlawn AFC – Resident Advancement
Provider/Agency Name - Other
Department
Job Title
Administration
Administrative Assistant
Administrator
Behavior Specialist
Behavior Technician
Behavioral Health Consultant
Billing Specialist
Buildings Manager
Care Coordinator
Case Manager
Clinical Therapist
Clubhouse Staff
Community Living Support - CLS Fiscal Intermediary
Community Living Support - CLS Fiscal Intermediary/SED Waiver
Community Living Support - CLS Provider
Intern
Job Coach
Licensed Residential Assistant Home Manager
Licensed Residential Direct Care Provider
Licensed Residential Home Manager
Maintenance
MDS Coordinator
Medication Administration Staff
Mental Health Supervisor
Mental Health Therapist
Mental Health Therapist - Teletherapy
Mental Health Therapist & Case Holder
Mental Health Therapist Mild/Moderate
Nurse Practitioner
Nurse Practioner - Telehealth
Occupational Therapist
Occupational Therapist - Autism
Outpatient Therapist - Teletherapy M2M
Parent Support Partner
Peer Support Specialist
Pharmacy Aide
Physical Therapist
Physical Therapist - Autism
Psychiatrist
Psychiatrist - Telehealth
Psychologist
Psychologist - Telehealth
Recovery Coach
Recreational Therapist
Registered Nurse
Respite Service Provider
Scheduler
Speech Therapist
Speech Therapist - Autism
Student Intern
Vehicle Operator
Other
Job Title - Other
Hire Date
(mm/dd/yyyy)
Termination Date
(mm/dd/yyyy)
Supervisor First Name
Supervisor Last Name
Supervisor Email
Population Served
This is necessary for determining training requirements for SPS & WGC depending on the population served.
Population Served
Adult
Child
Primary
Primary
Adult
Child
What services are provided to each population
This is necessary for determining training requirements for SPS & WGC depending on the services provided. If they are serving both, some are a MH Therapist for both or could be a MH Therapist for one population and a Case Holder for another.
What services are provided to each population
MH Therapist – Children
MH Therapist – Adults
Case Holder - Children
Case Holder – Adults
Are you an ABA Provider?
This is necessary in determining if ABA providers are eligible to complete SCCMHA training or not. There has been a history of 100s of OOC ABA providers, not serving SCCMHA, accessing and completing SCCMHA training out of convenience for work in other counties. This will lead to unnecessary increased usage of LMS.
No
Yes
Have they been credentialed? (Do not submit this form until credentialing is complete and approved)
This is necessary in determining if ABA providers are eligible to complete SCCMHA training or not. There has been a history of 100s of OOC ABA providers, not serving SCCMHA, accessing and completing SCCMHA training out of convenience for work in other counties. This will lead to unnecessary increased usage of LMS.
Yes
No
Previous SCCMHA Providers
SCCMHA must have the names of previous SCCMHA providers your staff has worked for. This may eliminate the need for this staff to complete training(s). This also ensures accuracy in training records. If you do not have this information, check with this staff before completing this form. Only enter NA If you are certain this staff has not worked for other Saginaw providers previously.
Other Fields
Your name
Your first name
Your last name
Your email address
Verification Code