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Provider Contact Information
BLACK ROCK ADULT LIVING LLC (Adult Family Home)
W4715 POTTER RD
ELKHORN, WI 53121

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Contact Name: Madison Micus
Telephone Number: (262) 348-6260
Fax Number: (262) 723-2182
Additional Provider Information
Licensure Status
REGULAR
License Number
0017481
Ownership Type
Limited Liability Company
Owner Name
BLACK ROCK ADULT LIVING LLC
Bed Capacity
4
Client Groups Served
ADVANCED AGED, DEVELOPMENTALLY DISABLED, PHYSICALLY DISABLED, TERMINALLY ILL, IRREVERSIBLE DEMENTIA/ALZHEIMER'S, EMOTIONALLY DISTURBED/MENTAL ILLNESS, TRAUMATIC BRAIN INJURY
HCBS Compliance / Public Funding Status
Compliant
Survey History

• For more information on the survey history, consult the Division of Quality Assurance survey information web site.

Survey TypeExit DateEnforcementStatement of DeficiencyPlan of Correction
VERIFICATION VISIT10/23/2024
  •  
SURVEY/COMPLAINT05/22/2024
  •  
Additional Resources
Filing a Complaint against a Wisconsin Health or Residential Care Entity
Consumer Guide to Health Care (includes provider directories)
Wisconsin Assisted Living Directories and Facility Profiles - Listed by county and by the type of assisted living provider type, then by facility name.
Guide to use when evaluating prospective facilities: Choosing an Assisted Living Facility (P-60579) (PDF, 124 KB)
Wisconsin Long Term Care and Support Services web page provides links to services and resources.
Wisconsin Alzheimer's Institute (exit DHS).
Alzheimer's Association:Choosing Health Care Providers and Facilities (exit DHS)
Wisconsin Board on Aging and Long Term Care Ombudsman Program (exit DHS)
Your Rights to Direct Your Future Health Care Needs (Advance Directives)
Wisconsin Client Rights
National Citizens' Coalition for Nursing Home Reform (NCCNHR) - Resources for Long-Term Care Consumers (exit DHS)
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