Facility Re-Certification RTC VA 12/02/2013. Program Addition SUDRF/PHP NC Facility Re-Certification RTC OH 12/12/2013
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1 January 10, 2014 To Whom It ay Concern: Attached is the TRICARE ental Health Certification List as of January 10, 2014 of reestanding Psychiatric Partial Hospitalization s (PHPs), Residential Treatment Centers (RTCs) and reestanding Substance Use Disorder Rehabilitation acilities (SUDRs). The following table lists status changes, which occurred through December 31, 2013: Name d/b/a Cumberland Hospital for Children and s 9407 Cumberland Road New Kent, VA 234 Phone: (804) EIN: Wilmington Treatment Center Wilmington Treatment Center, Inc Troy Drive Wilmington, NC Phone: (910) EIN: Belmont Pines Hospital 615 Churchill-Hubbard Road Youngstown, OH Phone: (330) EIN: Change Effective Re-Certification RTC VA /02/2013 Addition SUDR/PHP NC Re-Certification RTC OH //2013 KidsPeace National Centers, Inc KidsPeace Drive Orefield, PA Phone: EIN: Re-Certification RTC PA /19/2013 Sincerely, KEPRO/TRICARE 777 East Park Drive, Harrisburg, PA TRICARE HOTLINE: , AX ,
2 onthly ental Health Listing Report As of January 10, East Park Drive, Harrisburg, PA TRICARE HOTLINE: , AX ,
3 TABLE O CONTENTS LISTING O ENTAL HEALTH ACILITIES CERTIIED BY TRICARE Alabama 1 Alaska. 2 Arizona.. 2 Arkansas... 3 California.. 3 Colorado Connecticut lorida. 4 Georgia Hawaii Idaho. 8 Indiana Kansas. 9 Kentucky Louisiana 11 ississippi 11 aryland issouri. 11 ontana Nevada New exico North Carolina Ohio.. 15 Pennsylvania 15 South Carolina Tennessee. 17 Texas. 17 Utah 20 Virginia. 21 Washington. 24 Appendix A Glossary of Acronyms and Terms A1 777 East Park Drive, Harrisburg, PA TRICARE HOTLINE: , AX ,
4 Information ALABAA 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 onday - Sunday 11/29/ /03/2013 Sub Use ull Day onday - Sunday 11/29/ /03/2013 Page 1
5 Information ALABAA 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 onday- Saturday Certification 02/04/ /04/ /04/ /01/ /01/ /01/2013 ALASKA AK RTC DeBarr Residential Treatment Center rontline Hospital, LLC 1500 DeBarr Circle Anchorage, AK Phone: (907) EIN: Adult Sub Use ull Day Ages /16/ /26/2013 ARIZONA AZ RTC Southwest Children s Health Services dba Parc Place 2190 North Grace Boulevard Chandler, AZ Phone: EIN #: Ages Ages Ages /17/20 01/17/20 01/17/20 01/17/20 01/17/20 01/17/20 Ages Page /17/20 01/17/20
6 Information ARKANSAS AR RTC BHC Pinnacle Pointe Hospital inancial Center Parkway Little Rock, AR Phone: (501) EIN: CITC - ale-emale Ages 5- AITC - ale Ages Certification 07/22/ /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 onday-riday 32 05/07/ /11/2013 COLORADO 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 /19/ /19/1990 8/07/20 08/07/20 Connections Reactive Attachment Unit Ages 5- Page /07/20 08/07/20
7 Information Certification 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 LORIDA 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 Page /29/2009 5/29/2009 5/29/ /1/ /1/ /1/ /1/ /1/2013
8 Information Certification LORIDA 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: Adult Detox/Rehab Adult Sub Use ull Day Sub Use ull Day onday- Sunday onday- Sunday /19/ /19/ /19/ /01/20 11/01/20 11/01/20 L RTC University Behavioral, LLC d/b/a University Behavioral Center 2500 Discovery Drive Orlando, L Phone: EIN: Ages 6-17 Ages 6-17 emale emale Page /3/20 4/3/20
9 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 /14/ /26/2013 Page 6
10 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 PHP 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 7
11 Information Certification HAWAII 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/ /22/2010 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 8
12 INDIANA Information 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: Child/ Ages 6-18 Ages -20 Certification 29 08/16/ /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 KANSAS KS RTC KVC Hospitals, Inc. Prarie Ridge Psychiatric Hospital 4300 Brenner Drive Kansas City, KS Phone: EIN: Ages /14/20 3/14/20 Page 9
13 KENTUCKY KY RTC Information United Healthcare of Hardin, Inc. d/b/a Lincoln Trail behavioral Health System 3909 South Wilson Road Radcliff, KY Phone: EIN: Ages 9-17 Certification 18 8/23/2013 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 KY RTC Spring eadows Center d/b/a Spring eadows 330 Hope Street ount Washington, KY Phone: (502) EIN: Ages // //2013 Page 10
14 Information LOUISAINA LA PHP Addiction Recovery Resources, Inc Wabash etairie, LA Phone: (504) EIN: Substance Use Partial 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 ISSOURI O RTC Crittenton Children s Center Crittenton Center Elm Avenue Kansas City, O Phone: (816) EIN: Ages /08/ /14/2010 Page 11
15 Information ISSOURI 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 Certification 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 T RTC ACADIA ONTANA 55 Basin Creek Road Butte, T Phone: EIN: Child Ages /24/20 5/24/20 Page
16 NEVEDA Information Certification 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 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 /24/20 10/24/20 10/24/20 11/22/ /22/ /24/20 10/24/20 10/24/20 11/22/ /22/2013 Page 13
17 NORTH CAROLINA Information NC PHP Healthcare Solutions Network of North Carolina 170 Old Naples Road Hendersonville, NC Phone: (828) EIN: Adult Half Day onday - riday Certification 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 /30/2013 7/30/2013 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 /05/ /05/2003 /14/20 /03/2013 Page 14
18 Information Certification 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 SOUTH CAROLINA SC RTC Palmetto Lowcountry Behavioral Health 2777 Speissegger Drive Charleston, SC Phone: (843) EIN: EECTIVE 6/7/ TEPORARY SUSPENSION O RTC SERVICES DUE TO RENOVATIONS RTC 16 /7/2004 3/22/2013 Page 15
19 SOUTH CAROLINA Information SC RTC Palmetto Pines (Summerville) Behavioral Health 225 idland Parkway Summerville, SC Phone: EIN: Child/ RTC Ages 7-21 Certification 60 8/9/20 8/9/20 SC RTC Three Rivers Residential Treatment - idlands Campus 200 Ermine Road West Columbia, SC Phone: (803) EIN: KEYS Unit Ages KARS Child Unit Ages /26/2006 8//2011 8/6/2013 8/6/2013 SC PHP Three Rivers Residential Treatment - idlands Campus 200 Ermine Road West Columbia, SC Phone: (803) EIN: Pathways Partial 1 pm to 7 pm ull Day 20 04/22/2013 4/22/2013 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 Page 16
20 Information 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 s: onday- Thursday, Saturday Certification 4/30/2003 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 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 /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 Page 17
21 Information Certification TEXAS TX RTC Laurel Ridge Treatment Center Texas Laurel Ridge Hospital Corporate Woods Drive San Antonio, TX Phone: (800) EIN: Child /01/ /01/ /30/ /30/2011 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/ /01/ /01/ /01/2010 Child/ 15 01/01/ /01/2010 Page 18
22 TEXAS Information TX RTC Clarity Child Guidance Center (ormerly Southwest ental Health Center) 8535 Tom Slick Drive San Antonio, TX Phone: (210) EIN: Certification Child/ 52 02/22/1983 /05/2008 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/ /03/ /03/ /03/2011 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 Page 19
23 Information Certification TEXAS 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 UTAH UT RTC Center for Change UHS of Timpanogos 1790 North Street Orem, UT Phone: (801) EIN: 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/ /11/2010 UT RTC Provo Canyon School UHS of Provo Canyon, Inc East 750 North Orem, UT Phone: (801) EIN: RTC 48 02/09/ /09/2011 Page 20
24 Information VIRGINIA VA RTC Keystone Newport News, LLC Warwick Boulevard Newport News, VA Phone: (757) EIN: Ages Certification 24 06/09/ /13/20 VA RTC Harbor Point Behavioral Health Center 301 ort Lane Portsmouth, VA Phone: EIN: Ages Ages Gen Psych Ages /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 6/18/2010 VA RTC Riverside Behavioral Health Center 2244 Executive Drive Hampton, VA Phone: (757) EIN: Ages Ages /8/ /08/ /25/20 07/25/20 Page 21
25 Information VIRGINIA VA RTC The Kempsville Center for Behavioral Health 860 Kempsville Road Norfolk, VA Phone: (757) EIN: Ages Ages emale ale 22 Certification 11/27/ /27/ /15/ /15/2013 VA RTC Hallmark Youthcare - Richmond 800 West Creek Parkway Richmond, VA Phone: (804) EIN: Boys RTC 42 03/03/ /03/2011 VA SUDR Life Center of Galax 1 Painter Street Galax, VA Phone: (276) EIN: Adult Detox/Rehab Ages 18+ Adult ull Day Ages 18+ onday- Sunday /25/ /25/ /26/ /26/2013 VA RTC North Spring Behavioral Healthcare Victory Lane Leesburg, VA Phone: EIN: Ages /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
26 Information Certification VIRGINIA VA SUDR Williamsburg Place/The arley Center Diamond Healthcare of Williamsburg Inc oorestown Road Williamsburg, VA Phone: (757) EIN: Adult Detox Adult Inpatient Rehabilitation Adult Sub Use ull Day Adult Sub Use ull Day onday - riday Sunday - Saturday /13/ /13/ /13/ /13/ /13/ /13/ /13/ /13/2011 VA RTC The Barry Robinson Center 443 Kempsville Road Norfolk, VA Phone: (757) EIN: Gara Child RTC Ages 6-13 Grissom Child RTC Ages /24/ /10/ /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 Page 23 07/10/ /10/2013
27 WASHINGTON Information WA RTC Tamarack Center 2901 West ort George Wright Drive Spokane, WA Phone: (509) EIN: Certification 16 /22/1995 /24/2010 Page 24
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Voluntary Withdrawal from TRICARE Certification. TRICARE Certification Expired. Recent Certification Date Corrected to 6/30/2009
June 10, 2013 To Whom It ay Concern: Attached is the TRICARE ental Health Certification List as of June 10, 2013 of reestanding Psychiatric Partial Hospitalization s (PHPs), Residential Treatment Centers
New SUDRF Facility Adult Evening Half Day Partial (5:30 pm to 9:30 pm) Monday Thursday Capacity: 15 Age Range: 19+
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
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