Chapter 7 Addendum D (FY 2014) TRICARE-Authorized Residential Treatment Centers (RTCs) - FY 2014
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1 Mental Health Chapter 7 Addendum D (FY 2014) TRICARE-Authorized Residential Treatment Centers (RTCs) - FY 2014 The rates in this Addendum will be used for payment of claims for services rendered on or after October 1, The rates were adjusted by the lesser of the FY 2014 Medicare update factor (2.5%) or the amount that brought the rate up to the new cap amount of $843. This listing is for RTC per diem rates only. It does not reflect a facility s current status as a TRICAREauthorized RTC. Information regarding a facility s current status as an authorized provider can be obtained from the appropriate contractor. ALASKA DeBarr Residential Treatment Center Frontline Hospital, LLC 1500 DeBarr Circle Anchorage, AK EIN: ARIZONA Southwest Children s Health Services dba Parc Place 2190 North Grace Blvd Chandler, AZ EIN: ARKANSAS BHC Pinnacle Pointe Hospital Financial Center Parkway Little Rock, AR EIN: COLORADO CBR Youth Connect Hwy 109 La Junta, CO EIN: PSI Cedar Springs Hospital, Inc. Cedar Springs Behavioral Health Systems, Inc 2135 Southgate Road Colorado Springs, CO EIN:
2 FLORIDA LaAmistad Behavioral Health Services 1650 Park Avenue North Maitland, FL EIN: Manatee Palms Youth Service st Street West Bradenton, FL EIN: The National Deaf Academy, LLC RTC Hwy 441 Mt. Dora, FL EIN University Behavioral, LLC dba University Behavioral Center 2500 Discovery Drive Orlando, FL EIN: GEORGIA Coastal Harbor Treatment Center UHS of Savannah, LLC 1150 Cornell Avenue Savannah, GA EIN: Ramsey Youth Services of Georgia, Inc dba Macon Behavioral Health System 3500 Riverside Drive Macon, GA EIN: UHS of Laurel Heights, LP Laurel Heights Hospital 934 Briarcliff Road NE Atlanta, GA EIN: Youth Villages, Inc 4685 Dorsett Shoals Road Douglasville, GA EIN: HAWAII Kahi Mohala Behavioral Health Sutter Health Pacific Fort Weaver Road Ewa Beach, HI EIN:
3 Queen s Medical Center/Family Treatment Ctr The Queen s Healthcare System 1301 Punchbowl Honolulu, HI EIN: IDAHO Eastern Idaho Regional Medical Center - Behavioral Health Center 2280 E 25th Street Idaho Falls, ID EIN: INDIANA Michiana Behavioral Health Center HHC Indiana, Inc 1800 North Oak Road Plymouth, IN EIN: Valle Vista Hospital, LLC Valle Vista Health System 898 East Main Street Greenwood, IN EIN: KANSAS KVC Hospitals, Inc Prairie Ridge Psychiatric Hospital 4300 Brenner Drive Kansas City, KS EIN: KENTUCKY Spring Meadows Center dba Spring Meadows 330 Hope Street Mount Washington, KY EIN: Ten Broeck Hospital -- Dupont TBD Acquisition, LLC Louisville, KY EIN: Ten Broeck Hospital -- Louisville KMI Acquisition, LLC 8521 LaGrange Road Louisville, KY EIN:
4 United Healthcare of Hardin, Inc dba Lincoln Trail Behavioral Health System 3909 South Wilson Road Radcliff, KY EIN: MARYLAND Adventist Healthcare Inc dba Adventist Behavior Health Broschart Road Rockville, MD EIN: MISSOURI Crittenton Children s Center Elm Avenue Kansas City, MO EIN: Heartland Behavioral Health Services, Inc Great Plains Hospital, Inc 1500 W. Asland Nevada, MO EIN: Lakeland Regional Hospital Lakeland Hospital Acquisition Corporation 440 South Market Avenue Springfield, MO EIN: MONTANA Acadia Montana 55 Basin Creek Road Butte, MT EIN: Shodair Children s Hospital Montana Children s Home & Hospital 2755 Colonial Drive Helena, MT EIN: NEVADA Willow Springs Center Willow Springs, LLC 690 Edison Way Reno, NV EIN:
5 NEW MEXICO BHC Lovelace Sandia Health System BHC Mesilla Valley Hospital, LLC 3751 Del Ray Blvd Las Cruces, NM EIN: Youth and Family Centered Services of New Mexico, Inc dba Desert Hills 5310 Sequoia NW Albuquerque, NM EIN: NORTH CAROLINA Brynn Marr Hospital 192 Village Drive Jacksonville, NC EIN: OHIO Belmont Pines Hospital 615 Churchill-Hubbard Road Youngstown, OH EIN: PENNSYLVANIA KidsPeace National Centers 5300 KidsPeace Drive Orefield, PA EIN: SOUTH CAROLINA ABS LINCS SC, Inc dba Palmetto Pines Behavioral Health 225 Midland Parkway Summerville, SC EIN: Palmetto Lowcountry Behavioral Health 2777 Speissegger Drive Charleston, SC EIN: Three Rivers Residential Treatment - Midlands Campus 200 Ermine Road West Columbia, SC EIN:
6 TENNESSEE Compass Intervention Center Keystone Memphis, LLC 7900 Lowrance Road Memphis, TN EIN: TEXAS Cedar Crest Hospital and RTC HMTH Cedar Crest, LLC 3500 South IOH - 35 Belton, TX EIN: Laurel Ridge Treatment Center Texas Laurel Ridge Hospital Corporate Woods Drive San Antonio, TX EIN: Meridell Achievement Center W Hwy 29 Liberty Hill, TX EIN San Marcos Treatment Center Texas San Marcos Treatment, LP 120 Bert Brown Road San Marcos, TX EIN: Southwest Mental Health Center 8535 Tom Slick Drive San Antonio, TX EIN: UTAH UHS of Provo Canyon, Inc / Provo Canyon School 4501 North University Avenue Provo, UT EIN: UHS of Provo Canyon, Inc / Provo Canyon School 1350 East 750 North Orem, UT EIN: UHS of Timpanogos Center of Change 1790 N. State Street Orem, UT EIN:
7 VIRGINIA Cumberland Hospital for Children and Adolescents dba Cumberland Hospital 9407 Cumberland Road New Kent, VA EIN Hallmark Youthcare - Richmond West Creek Parkway Richmond, VA EIN: Harbor Point Behavioral Health Center 301 Fort Lane Portsmouth, VA EIN: The James Barry Robinson Institute dba The Barry Robinson Center 443 Kempsville Road Norfolk, VA EIN: Newport News Behavioral Health Center Warwick Blvd Newport News, VA EIN: North Spring Behavioral Healthcare Victory Lane Leesburg, VA EIN: The Pines Residential Treatment Center - Kempsville 860 Kempsville Road Norfolk, VA EIN: Poplar Springs West HHC Poplar Springs, Inc 350 Poplar Drive Petersburg, VA EIN: Riverside Health Behavioral Center 2244 Executive Drive Hampton, VA EIN:
8 WASHINGTON Tamarack Center 2901 West Fort George Wright Drive Spokane, WA EIN: END - 8
Chapter 7 Addendum D (FY 2015) TRICARE-Authorized Residential Treatment Centers (RTCs) - FY 2015
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