New SUDRF Facility Adult Evening Half Day Partial (5:30 pm to 9:30 pm) Monday Thursday Capacity: 15 Age Range: 19+

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1 April 7, 2014 To Whom It ay Concern: Attached is the TRICARE ental Health Certification List as of April 7, 2014 of reestanding Psychiatric Partial Hospitalization Programs (PHPs), Residential Treatment Centers (RTCs) and reestanding Substance Use Disorder Rehabilitation acilities (SUDRs). The following table lists status changes, which occurred through April 7, 2014: Name d/b/a Bradford Health Services - PENSACOLA 2101 agnolia Avenue South Suite 518 Birmingham, AL Phone: EIN: Bradford Health Services - WARRIOR LODGE 1189 Allbritton Road Warrior, AL Phone: (205) EIN: Change Effective New SUDR Adult Evening Half Day Partial (5:30 pm to 9:30 pm) onday Thursday : 15 Age Range: 19+ SUDR/PHP AL 3/4/2014 Re-Certification of SUDR / AL 3/4/2014 PHP San arcos Treatment Center 0 Bert Brown Road San arcos, TX Phone: (615) EIN: Re-Certification of RTC TX 3/4/2014 Springbrook Behavioral Health System One Havenwood Lane Travelers Rest, SC Phone: EIN: New RTC ental Health/Autism Dual Diagnosis Unit Ages -18 ale / emale : 18 Child RTC Ages 5- ale/emale : 14 RTC SC 3/26/ East Park Drive, Harrisburg, PA TRICARE HOTLINE: , AX ,

2 Name d/b/a Change Effective ale Ages - 18 : 18 Spring eadows Center d/b/a Spring eadows 330 Hope Street ount Washington, KY Phone: (502) EIN: emale Ages onth Voluntary Suspension of Services RTC KY 04/03/2014 Sincerely, KEPRO/TRICARE 777 East Park Drive, Harrisburg, PA TRICARE HOTLINE: , AX ,

3 onthly ental Health Listing Report As of April 7, East Park Drive, Harrisburg, PA TRICARE HOTLINE: , AX ,

4 TABLE O CONTENTS LISTING O ENTAL HEALTH ACILITIES CERTIIED BY TRICARE Alabama 1 Alaska. 2 Arizona.. 3 Arkansas... 3 California.. 3 Colorado Connecticut lorida. 5 Georgia Hawaii Idaho. 9 Illinois Indiana Kansas. 11 Kentucky Louisiana aryland.. ississippi... issouri. 13 ontana 13 Nevada New exico North Carolina Ohio.. 16 Pennsylvania 16 South Carolina Tennessee. 18 Texas. 19 Utah 22 Virginia. 22 Washington. 26 Appendix A Glossary of Acronyms and Terms A1 777 East Park Drive, Harrisburg, PA TRICARE HOTLINE: , AX ,

5 ALABAA Information AL SUDR Bradford Health Services - Huntsville 555 Sparkman Drive, Suite 208 Huntsville, AL Phone: (256) EIN: Adult Evening Sub Use Half Day Evening Use Half Day Adult id Day onday- Thursday onday - Thursday onday - Thursday 10 Certification 10/07/ /07/ /07/ /23/ /23/ /23/2013 Adult orning onday- Thursday 10/07/ /23/2013 AL SUDR Bradford Health Services - Huntsville Lodge 1600 Browns erry Road adison, AL Phone: (256) EIN: /Adult Inpatient Rehab Ages Adult Inpatient Rehab/Detox /29/ /29/ /03/ /03/2013 Adult Sub Use ull Day Sub Use ull Day onday - Sunday onday - Sunday 11/29/ /29/ /03/ /03/2013 Page 1

6 ALABAA Information AL SUDR Bradford Health Services - Pensacola 2101 agnolia Avenue South Suite 518 Birmingham, AL EIN: Adult Evening - Half Day Partial Ages 19+ onday - Thursday (5:30 pm - 9:30 pm) Certification 15 3/4/2014 3/4/2014 AL SUDR Bradford Health Services - Warrior Lodge 1189 Allbritton Road Warrior, AL Phone: (205) EIN: Adult Detox Adult Inpatient Rehabilitation Adult Sub Use ull Day Adult Sub Use ull Day onday- Saturday /04/ /04/ /04/ /04/ /04/ /04/2014 ALASKA AK RTC DeBarr Residential Treatment Center rontline Hospital, LLC 1500 DeBarr Circle Anchorage, AK Phone: (907) EIN: Ages 6-18 Page /16/ /26/2013

7 ARIZONA Information AZ RTC Southwest Children s Health Services dba Parc Place 2190 North Grace Boulevard Chandler, AZ Phone: EIN #: Ages Ages Ages Certification 01/17/20 01/17/20 01/17/20 01/17/20 01/17/20 01/17/20 Ages /17/20 01/17/20 ARKANSAS AR RTC BHC Pinnacle Pointe Hospital inancial Center Parkway Little Rock, AR Phone: (501) EIN: CITC - ale-emale Ages 5- AITC - ale Ages /22/ /22/ /26/20 08/26/20 AITC - emale Ages /26/20 CALIORNIA CA SUDR Lasting Recovery arkas & Saalinger Psychological Corp 6046 Cornerstone Ct W. #13 San Diego, CA 921 Phone: (858) EIN: Adult Sub Use ull Day Page 3 onday-riday 32 05/07/ /11/2013

8 COLORADO Information CO RTC Cedar Springs Behavioral Health Systems, Inc. PSI Cedar Springs Hospital, Inc Southgate Road Colorado Springs, CO Phone: (719) EIN: ountain View Place - Child Ages 5- ountain View Place - Ages Certification 10/19/ /19/1990 8/07/20 08/07/20 Connections Reactive Attachment Unit Ages /07/20 08/07/20 CONNECTICUT CT SUDR Stonington Institute Stonington Behavioral Health, Inc. 75 Swanton Hill Road North Stonington, CT Phone: (860) EIN: Adult ull Day Adult Inpatient Rehabilitation Detox/Inpt. Rehab onday-riday /28/ /28/ /28/ /24/ /24/ /23/2013 Page 4

9 LORIDA Information Certification L RTC LaAmistad Behavioral Health Services LaAmistad Behavioral Health Services 1650 Park Avenue North aitland, L Phone: (407) EIN: Ages -18 Child Ages 5-11 & /23/1999 7/23/1999 7/5/2011 7/5/2011 L RTC Palm Shores Behavioral Health Center (ormerly anatee Palms Youth Services) (Premier Behavioral Solutions of lorida, Inc.) th Avenue East Bradenton, L Phone: (941) EIN: Child Ages 5- Ages Ages /29/2009 5/29/2009 5/29/ /1/ /1/ /1/ /1/ /1/2013 Page 5

10 LORIDA Information Certification L RTC National Deaf Academy U.S. Highway 441 t. Dora, L Phone: (352) EIN: Child/ Bldg Ages Adult Building 7 Ages /13/2011 9/13/2011 3/18/2013 3/18/2013 L SUDR The riary The riary of Lakeview 4400 Hickory Shores Blvd Gulf Breeze, L Phone: (850) EIN: Adult Detox Adult Inpatient Rehabilitation Adult Sub Use Partial- ull Day onday- Saturday /17/1993 2/16/2011 L SUDR Twelve Oaks Alcohol & Drug Treatment Center Bowling Green Inn of Pensacola 2068 Healthcare Avenue Navarre, L Phone: (850) EIN: L RTC University Behavioral, LLC d/b/a University Behavioral Center 2500 Discovery Drive Orlando, L Phone: EIN: Adult Detox/Rehab Adult Sub Use ull Day Sub Use ull Day Ages 6-17 Ages 6-17 emale emale onday- Sunday onday- Sunday /19/ /01/20 07/19/ /01/20 07/19/ /01/20 4/3/20 4/3/20 Page 6

11 Information GEORGIA GA SUDR Bradford Health Services - Augusta 105 Rossmore Place Augusta, GA Phone: (706) EIN: /Adult Sub Use Half Day Adult Evening Sub Use Half Day onday- Thursday, Saturday onday- Thursday 8 Certification 10/05/ /05/ /26/ /26/2013 GA SUDR Bradford Health Services - Columbus 860 Brookstone Center Parkway Suite A Columbus, GA Phone: (706) EIN: Adult Evening Sub Use Half Day Evening Sub Use Half Day onday- Thursday onday - Thursday 18 8 /27/2007 /27/2007 4/25/2013 4/25/2013 GA RTC Coastal Harbor Treatment Center UHS of Savannah, LLC 1150 Cornell Avenue Savannah, GA Phone: (9) EIN: One East Ages One North Ages 9-13 emale ale /18/2008 2/15/20 GA RTC Laurel Heights UHS Laurel Heights L.P. 934 Briarcliff Road NE Atlanta, GA Phone: (404) EIN: Ages Page /14/ /26/2013

12 Information GEORGIA GA RTC Ramsey Youth Services of Georgia, Inc., d/b/a acon Behavioral Health System 3500 Riverside Drive acon, GA 310 Phone: (478) EIN: Child & Ages 7-21 Certification 38 11/15/20 11/15/20 GA SUDR Recovery Place, Inc. Recovery Place, Inc. 835 East 65th Street Savannah, GA Phone: (9) EIN: Adult ull Day Adult Half Day onday-riday onday-riday /05/ /05/ /19/ /19/2010 GA SUDR Talbott Columbus 00 Brookstone Centre Parkway Suite 210 Columbus, GA Phone: (706) EIN: Adult Substance Use Partial - ull Day Adult Substance Use Partial - Half Day onday-riday onday-riday 02/02/20 02/02/20 02/02/20 02/02/20 GA RTC Youth Villages Youth Villages, Inc Dorsett Shoals Road Douglasville, GA Phone: (901) EIN: /30/1997 4/26/2013 Page 8

13 HAWAII Information Certification HI RTC Kahi ohala Behavioral Health Sutter Health Pacific ort Weaver Road Ewa Beach, HI Phone: (808) EIN: Child & /16/ /06/2011 HI RTC The Queen s edical Center/ amily Treatment Center The Queen's edical Center 1301 Punchbowl Honolulu, HI Phone: (808) EIN: Unit East Child /08/ /08/ /22/ /22/2013 IDAHO ID RTC Eastern Idaho Regional edical Center - Behavioral Health Center Eastern Idaho Health Services, Inc East 25th Street Idaho alls, ID Phone: (208) EIN: RTC 22 10/19/ /06/2013 Page 9

14 ILLINOIS Information IL RTC Timberline Knolls TK Behavioral, LLC 40 Timberline Drive Lemont, IL Phone: (630) EIN#: INDIANA IN RTC ichiana Behavioral Health Center HHC Indiana, Inc North Oak Road Plymouth, IN Phone: (574) EIN: IN RTC idwest Center for Youth and amilies South Shore Academy 10 W. Indiana Street Kouts, IN EIN: Ages -20 Child/ Ages 6-18 Ages -20 Certification 35 2/25/2014 2/25/ /16/ /09/2013 emale 15 08/22/ /22/2013 IN RTC Valle Vista Health System Valle Vista Hospital, LLC. 898 East ain Street Greenwood, IN Phone: (317) EIN: Ages -18 Ages /16/ /16/ /16/ /16/2013 Page 10

15 KANSAS Information KS RTC KVC Hospitals, Inc. Prarie Ridge Psychiatric Hospital 4300 Brenner Drive Kansas City, KS Phone: EIN: Ages 6-18 Certification 3/14/20 3/14/20 KENTUCKY KY RTC United Healthcare of Hardin, Inc. d/b/a Lincoln Trail behavioral Health System 3909 South Wilson Road Radcliff, KY Phone: EIN: Ages /23/2013 8/23/2013 KY RTC The Brook Hospitals - Dupont TBD Acquisition, LLC Browns Lane Louisville, KY Phone: (502) EIN: Child Ages /02/ /19/2013 KY RTC The Brook Hospitals - KI KI Acquisition 8521 LaGrange Road Louisville, KY Phone: (502) EIN: Ages Ages /8/ /08/ /19/ /19/2013 Page 11

16 LOUISAINA Information LA SUDR Addiction Recovery Resources, Inc Wabash etairie, LA Phone: (504) EIN: Substance Use Partial Program Ages 18+ & onday to riday 9 am to 8 pm Certification 20 10/10/ /10/2013 ARYLAND D RTC Adventist Healthcare, Inc Adventist Behavioral Health Broschart Road Rockville, D Phone: (301) EIN: Ages /2 Ages / /06/ /06/ /22/ /22/2013 ISSISSIPPI S RTC ILLCREEK O PONTOTOC 1814 Highway 15 North Pontotoc, S Phone: EIN#: RTC Ages /21/ /21/2013 Page

17 Information ISSOURI O RTC Crittenton Children s Center Crittenton Center Elm Avenue Kansas City, O Phone: (816) EIN: Ages Certification 13 01/08/ /14/2010 O RTC Heartland Behavioral Health Services, Inc. Great Plains Hospital, Inc West Ashland Nevada, O Phone: (417) EIN: O RTC Lakeland Regional Hospital Lakeland Hospital Acquisition Corporation 440 South arket Avenue Springfield, O Phone: (417) EIN: Specialized Boys/Girls 2 North and Northeast Units 36 08/15/ /11/ Apr 10/8/2007 9/19/2013 ONTANA T RTC Shodair Children s Hospital ontana Children's Home & Hospital 2755 Colonial Drive Helena, T Phone: (406) EIN: Child /25/2003 8/25/2003 8/25/ /24/ /24/ /24/2013 Page 13

18 Information ONTANA T RTC ACADIA ONTANA 55 Basin Creek Road Butte, T Phone: EIN: Child Ages Certification 14 5/24/20 5/24/20 NEVEDA NV RTC Willow Springs Center Willow Springs, LLC 690 Edison Way Reno, NV Phone: (775) EIN: Child /08/ /08/ /08/ /26/ /26/ /26/2013 NEW EXICO N RTC esilla Valley Hospital BHC esilla Valley Hospital, LLC 3751 Del Rey Boulevard Las Cruces, N 880 Phone: (800) EIN: /05/ /05/ /09/ /09/2011 Page 14

19 NEW EXICO Information N RTC Desert Hills Youth and amily Centered Services of New exico, Inc., d/b/a Desert Hills 5310 Sequoia NW Albuquerque, N 870 Phone: (505) EIN: Child emale ale ale emale Certification 10/24/20 10/24/20 10/24/20 11/22/ /22/ /24/20 10/24/20 10/24/20 11/22/ /22/2013 NORTH CAROLINA NC PHP Healthcare Solutions Network of North Carolina 170 Old Naples Road Hendersonville, NC Phone: (828) EIN: Adult Half Day onday - riday 60 08/13/ /11/2010 NC RTC Brynn arr Hospital Brynn arr Hospital 192 Village Drive Jacksonville, NC Phone: (910) EIN: /21/2007 7//2013 NC RTC SBH - Wilmington LLC d/b/a Strategic Behavioral Center - Wilmington 2050 ercantile Drive Leland, NC EIN: Ages -17 Page /30/2013 7/30/2013

20 NORTH CAROLINA Information NC SUDR Wilmington Treatment Center Wilmington Treatment Center, Inc Troy Drive Wilmington, NC Phone: (910) EIN: Adult Inpatient Rehab/Detox Ages Adult Sub Use ull Day Ages onday- Sunday Certification 05/05/ /05/2003 /03/2013 /03/2013 OHIO OH RTC Belmont Pines Hospital Belmont Pines Hospital 615 Churchill-Hubbard Road Youngstown, OH Phone: (330) EIN: Child Ages 5-11 Ages /02/2009 //2013 PENNSYLVANIA PA RTC KidsPeace National Centers, Inc KidsPeace Drive Orefield, PA Phone: EIN: Ages & 24 4/5/20 /19/2013 Page 16

21 SOUTH CAROLINA Information SC RTC Palmetto Pines (Summerville) Behavioral Health 225 idland Parkway Summerville, SC Phone: EIN: SC RTC Three Rivers Residential Treatment - idlands Campus 200 Ermine Road West Columbia, SC Phone: (803) EIN: Child/ RTC Ages 7-21 KEYS Unit Ages KARS Child Unit Ages 6-11 Certification 60 8/9/20 8/9/ /26/2006 8//2011 8/6/2013 8/6/2013 SC SUDR Earle E. orris Jr. Alcohol & Drug Addiction Treatment 610 aison Drive Columbia, SC Phone: (803) EIN: Adult Detox Adult Inpatient Rehabilitation Adult Inpatient Rehabilitation 24 04/27/ /27/ /27/ /30/ /30/ /30/2013 Dual Diagnosis Inpatient Rehab/Detox 04/27/ /30/2013 SC RTC New Hope Carolinas, Inc. 101 Sedgewood Drive Rock Hill, SC Phone: (843) EIN: Ages //2014 2//2014 Page 17

22 SOUTH CAROLINA Information SC PHP Three Rivers Residential Treatment - idlands Campus 200 Ermine Road West Columbia, SC Phone: (803) EIN: Pathways Partial Program 1 pm to 7 pm ull Day Certification 20 04/22/2013 4/22/2013 SC RTC SPRINGBROOK BEHAVIORAL HEALTH SYSTE One Havenwood Lane Travelers Rest, SC Phone: EIN: Ages -18 Child Ages 5- Ages /26/ /26/ /26/ /26/ /26/ /26/2014 Ages /26/ /26/2014 TENNESSEE TN SUDR Bradford Health Services - Clarksville 235 A Dunbar Cave Road Clarksville, TN Phone: (931) EIN: Adult Evening Sub Use Half Day Adult ull Day Adult ull Day All Programs: onday- Thursday, Saturday /30/2003 4/30/2003 4/30/2003 6/26/2013 6/26/2013 6/26/2013 Evening Sub Use Half Day 10 4/30/2003 6/26/2013 Page 18

23 TENNESSEE Information TN RTC Compass Intervention Center Keystone emphis, LLC 7900 Lowrance Road emphis, TN 385 Phone: (901) EIN: Ages -18 Child Ages 6-11 Ages -18 emale ale Certification 07/26/ /10/ /26/ /26/ /26/ /26/2013 TEXAS TX RTC Cedar Crest Hospital and RTC HTH Cedar Crest, LLC 3500 South IOH-35 Belton, TX Phone: (254) EIN: Ages /01/ /28/2013 TX RTC Laurel Ridge Treatment Center Texas Laurel Ridge Hospital Corporate Woods Drive San Antonio, TX Phone: (800) EIN: Child /01/ /01/ /30/20 11/30/20 Page 19

24 TEXAS Information Certification TX RTC eridell Achievement Center 550 West Hwy 29 Liberty Hill, TX Phone: (800) EIN: PSYCH RTC Ages -18 NEURO PSYCH RTC Ages /10/ /10/ /18/ /18/2013 NURO PSYCH RTC Ages /10/ /18/2013 NEURO PSYCH RTC Ages /10/ /18/2013 CHILD NEURO PSYCH RTC Ages /10/ /18/2013 TX RTC San arcos Treatment Center 0 Bert Brown Road San arcos, TX Phone: (615) EIN: Child/ Child/ Child/ /01/ /01/ /01/ /04/ /04/ /04/2014 Child/ 15 01/01/ /04/2014 Page 20

25 TEXAS Information Certification TX PHP El Paso Psychiatric Assoc. PA Alternative Centre 7760 Alabama Street El Paso, TX Phone: (915) EIN: Adult Sub Use ull Day Adult Sub Use Half Day Sub Use Half Day onday - riday onday - riday onday - riday /03/ /03/ /03/ /28/ /28/ /28/2013 TX SUDR Red River Recovery Center Red River Recovery, LLC 2501 Taylor Street Wichita alls, TX Phone: (940) EIN: Adult Sub Use ull Day 7 days 18 02/05/ /31/2013 TX SUDR Starlite Recovery Center 230 esa Verde Drive - East P.O. Box 317 Center Point, TX Phone: (830) EIN: Adult Detox Ages Adult Rehab/Res Ages Adult PHP - ull Day ull Day onday - riday /17/ /17/ /17/ /26/ /26/ /26/2013 Page 21

26 UTAH Information UT RTC Center for Change UHS of Timpanogos 1790 North Street Orem, UT Phone: (801) EIN: Certification RTC 24 /24/2010 /24/2010 UT RTC Provo Canyon School UHS of Provo Canyon, Inc North University Avenue Provo, UT Phone: (801) EIN: Intensive Diagnostic & Stabilization Unit Ages ale 08/11/ /15/2013 UT RTC Provo Canyon School UHS of Provo Canyon, Inc East 750 North Orem, UT Phone: (801) EIN: RTC 48 02/09/ /09/2011 VIRGINIA VA RTC Keystone Newport News, LLC Warwick Boulevard Newport News, VA Phone: (757) EIN: Ages /09/ /13/20 Page 22

27 VIRGINIA Information VA RTC Harbor Point Behavioral Health Center 301 ort Lane Portsmouth, VA Phone: EIN: Ages Ages Gen Psych Ages Certification 05/07/20 05/07/20 /07/20 /07/20 /07/20 /07/20 Child RTC Unit Ages 6-24 /07/20 /07/20 VA RTC Poplar West HHC Poplar Springs, Inc. 350 Poplar Drive Petersburg, VA Phone: (804) EIN: Ages Ages /24/1993 6/30/20 6/30/20 VA RTC Riverside Behavioral Health Center 2244 Executive Drive Hampton, VA Phone: (757) EIN: Ages Ages /8/ /08/ /25/20 07/25/20 Page 23

28 VIRGINIA Information VA RTC The Kempsville Center for Behavioral Health 860 Kempsville Road Norfolk, VA Phone: (757) EIN: VA RTC Hallmark Youthcare - Richmond 800 West Creek Parkway Richmond, VA Phone: (804) EIN: Ages Ages emale ale 22 Certification 11/27/ /27/ /15/ /15/2013 Boys RTC 42 03/03/ /03/2011 VA SUDR Life Center of Galax 1 Painter Street Galax, VA Phone: (276) EIN: VA RTC North Spring Behavioral Healthcare Victory Lane Leesburg, VA Phone: EIN: Adult Detox/Rehab Ages 18+ Adult ull Day Ages 18+ Ages onday- Sunday /25/ /25/ /26/ /26/ /8/20 3/8/20 VA RTC Cumberland Hospital for Children and s 9407 Cumberland Road New Kent, VA 234 Phone: (804) EIN: Ages Ages Page /27/ /27/2011 /02/2013 /02/2013

29 VIRGINIA Information Certification VA SUDR Williamsburg Place/The arley Center Diamond Healthcare of Williamsburg Inc oorestown Road Williamsburg, VA Phone: (757) EIN: VA RTC The Barry Robinson Center 443 Kempsville Road Norfolk, VA Phone: (757) EIN: Adult Detox Adult Inpatient Rehabilitation Adult Sub Use ull Day Adult Sub Use ull Day Gara Child RTC Ages 6-13 Grissom Child RTC Ages 6-13 onday - riday Sunday - Saturday /13/ /13/ /13/ /13/ /24/ /10/ /13/ /13/ /13/ /13/ /24/ /10/2013 K-House Child RTC Ages /10/ /10/2013 Lawless RTC Ages /10/ /10/2013 Power RTC Ages /10/ /10/2013 Wilcox RTC Ages /10/ /10/2013 Page 25

30 Information Certification WASHINGTON WA RTC Tamarack Center 2901 West ort George Wright Drive Spokane, WA Phone: (509) EIN: /22/1995 /24/2010 Page 26

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Voluntary Withdrawal from TRICARE Certification. TRICARE Certification Expired. Recent Certification Date Corrected to 6/30/2009

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