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 (RTCs) and reestanding Substance Use Disorder Rehabilitation acilities (SUDRs). The following table lists status changes, which occurred ay 1-31, 2013: Name / Dba Change Eastern Idaho Regional edical Center - Behavioral Health Center Eastern Idaho Health Services, Inc. 2280 East 25th Street Idaho alls, ID 83404 Phone: (208) 227-2100 EIN: 820436622 Effective RTC ID 5/30/2013 LaAmistad Behavioral Health Services d/b/a Central lorida Behavioral Health 6601 Central lorida Parkway Orlando, L 32821 Phone: 407-370-0111 EIN: 581791069 Addiction Recovery Resources, Inc. Addiction Recovery Resources, Inc. 4836 Wabash etairie, LA 70001 Phone: (504) 780-2766 EIN: 264332101 Lakeland Regional Hospital Lakeland Hospital Acquisition Corporation 440 South arket Avenue Springfield, O 65806 Phone: (417) 865-5581 EIN: 582291915 Voluntary Withdrawal from TRICARE Certification TRICARE Certification Expired Recent Corrected to 6/30/2009 RTC L 05/16/2013 SUDR LA 05/13/2013 RTC O 5/29/2013 Sincerely, KePRO/TRICARE 777 East Park Drive, Harrisburg, PA 17111-2754 TRICARE HOTLINE: 1-877-841-6413, AX 1-877-841-6414, http://www.tricare.kepro.com
onthly ental Health Listing Report As of ay 30, 2013
TABLE O CONTENTS LISTING O ENTAL HEALTH ACILITIES CERTIIED BY TRICARE Alabama. 1 Alaska.. 2 Arizona.. 3 Arkansas... 3 California.. 4 Colorado..... 4 Connecticut.... 5 lorida. 6 Georgia..... 8 Hawaii.... 10 Indiana.... 11 Kansas. Kentucky... aryland... 13 issouri. 13 ontana 15 Nevada... 15 New exico... 16 North Carolina... 17 Ohio.. 18 Pennsylvania 18 South Carolina... 18 Tennessee. 20 Texas. 21 Utah 25 Virginia. 26 Washington. 30 Appendix A Glossary of Acronyms and Terms A1
Information ALABAA AL SUDR Bradford Health Services - Huntsville 555 Sparkman Drive, Suite 208 Huntsville, AL 35816 Phone: (256) 895-3848 EIN: 631198286 Adult Evening Sub Use Half Day Evening Use Half Day Adult id Day onday- Thursday onday - Thursday onday - Thursday 10 10/07/2002 10/07/2002 10/07/2002 04/27/2009 04/27/2009 04/27/2009 Adult orning onday- Thursday 10/07/2002 04/27/2009 AL SUDR Bradford Health Services - Huntsville Lodge 1600 Browns erry Road adison, AL 35758 Phone: (256) 461-7272 EIN: 631198286 /Adult Inpatient Rehab Age 14-18 Adult Inpatient Rehab/Detox 40 44 11/29/1993 11/29/1993 06/16/2009 06/16/2009 Adult Sub Use ull Day onday - Sunday 11/29/1993 06/16/2009 Sub Use ull Day onday - Sunday 11/29/1993 06/16/2009 Page 1
Information ALABAA AL SUDR Bradford Health Services - Warrior Lodge 1189 Allbritton Road Warrior, AL 35180 Phone: (205) 647-1945 EIN: 631198286 Adult Detox Adult Inpatient Rehabilitation Adult Sub Use ull Day onday- riday 28 57 35 02/04/1993 02/04/1993 02/04/1993 01/07/2009 01/07/2009 01/07/2009 ALASKA AK RTC DeBarr Residential Treatment Center rontline Hospital, LLC 1500 DeBarr Circle Anchorage, AK 99508 Phone: (907) 258-7575 EIN: 721539254 (Age 6-18) 60 07/16/2008 08/28/2009 Page 2
Information ARIZONA AZ RTC Southwest Children s Health Services dba Parc Place 2190 North Grace Boulevard Chandler, AZ 85225 Phone: 408-917-9301 EIN #: 860768611 (Age 11-15) (Age 15-17) (Age 11-17) 22 18 11 01/17/20 01/17/20 01/17/20 01/17/20 01/17/20 01/17/20 (Age 11-17) 26 01/17/20 01/17/20 ARKANSAS AR RTC BHC Pinnacle Pointe Hospital 11501 inancial Center Parkway Little Rock, AR 72211 Phone: (501) 223-3322 EIN: 621658502 CITC - ale-emale Age 5- AITC - ale Age -17 16 18 07/22/1994 07/22/1994 08/26/20 08/26/20 AITC - emale Age -17 22 08/26/20 Page 3
Information CALIORNIA CA SUDR Lasting Recovery arkas & Saalinger Psychological Corp 6046 Cornerstone Ct W. #13 San Diego, CA 921 Phone: (858) 453-4315 EIN: 202291188 Adult Sub Use ull Day onday-riday 32 05/07/2010 05/07/2010 COLORADO CO RTC CBR Youth Connect CBR Youth Connect 28071 Hwy 109 La Junta, CO 81050 Phone: (719) 384-5981 EIN: 840500375 Age 10-20 21 08/20/2007 11/16/2009 Page 4
Information COLORADO CO RTC Cedar Springs Behavioral Health Systems, Inc. PSI Cedar Springs Hospital, Inc. 2135 Southgate Road Colorado Springs, CO 80906 Phone: (719) 633-4114 EIN: 743081810 ountain View Place - Child Age 5- ountain View Place - Age -18 24 24 10/19/1990 10/19/1990 8/07/20 08/07/20 Connections Reactive Attachment Unit Age 5-10 08/07/20 08/07/20 CONNECTICUT CT SUDR Stonington Institute Stonington Behavioral Health, Inc. 75 Swanton Hill Road North Stonington, CT 06359 Phone: (860) 439-6005 EIN: 200687971 Adult ull Day Adult Inpatient Rehabilitation Detox/Inpt. Rehab onday-riday 24 25 13 01/28/2010 01/28/2010 01/28/2010 01/24/2013 01/24/2013 01/23/2013 Page 5
Information LORIDA L RTC LaAmistad Behavioral Health Services LaAmistad Behavioral Health Services 1650 Park Avenue North aitland, L 32751 Phone: (407) 647-0660 EIN: 581791069 (Age -18) Child (Age 5-11) & 34 6 7/23/1999 7/5/2011 L RTC anatee Palms Youth Services Premier Behavioral Solutions of lorida, Inc. 4480 51st Street West Bradenton, L 34210 Phone: (941) 792-2222 EIN: 650816927 Ages 13-17 Ages 13-17 Child Ages 5-20 20 20 5/29/2009 7/19/2010 L RTC National Deaf Academy 19650 U.S. Highway 441 t. Dora, L 32757 Phone: (352) 735-9500 EIN: 593653865 Child/ Bldg Ages 11-17 Adult Building 7 Ages 18-21 36 9/13/2011 9/13/2011 Page 6
Information LORIDA L SUDR The riary The riary of Lakeview 4400 Hickory Shores Blvd Gulf Breeze, L 32563 Phone: (850) 932-9375 EIN: 590737872 Adult Detox Adult Inpatient Rehabilitation Adult Sub Use Partial-ull Day onday- Saturday 10 8 19/17/1993 2/16/2011 L SUDR Twelve Oaks Alcohol & Drug Treatment Center Bowling Green Inn of Pensacola 2068 Healthcare Avenue Navarre, L 32566 Phone: (850) 939-00 EIN: 581795523 Adult Detox/Rehab Adult Sub Use ull Day Sub Use ull Day onday- Sunday onday- Sunday 16 70 16 07/19/1993 07/19/1993 07/19/1993 11/01/20 11/01/20 11/01/20 L RTC University Behavioral, LLC d/b/a University Behavioral Center 2500 Discovery Drive Orlando, L 32826 Phone: 407-281-7000 EIN: 205202458 Ages 6-17 Ages 6-17 emale emale 16 16 4/3/20 4/3/20 Page 7
Information GEORGIA GA SUDR Bradford Health Services - Augusta 105 Rossmore Place Augusta, GA 30909 Phone: (706) 854-16 EIN: 631198286 /Adult Sub Use Half Day Adult Evening Sub Use Half Day onday- Thursday, Saturday onday- Thursday 8 10/05/2005 10/05/2005 03/23/2011 03/23/2011 GA SUDR Bradford Health Services - Columbus 860 Brookstone Center Parkway Suite A Columbus, GA 31904 Phone: (706) 649-3075 EIN: 631198286 Adult Evening Sub Use Half Day Evening Sub Use Half Day onday- Thursday onday - Thursday 18 8 /27/2007 /27/2007 01/10/2011 01/10/2011 GA RTC Coastal Harbor Treatment Center UHS of Savannah, LLC 1150 Cornell Avenue Savannah, GA 31406 Phone: (9) 354-3911 EIN: 200931196 One East Age 13-17 One North Age 9-13 emale ale 15 15 1/18/2008 2/15/20 Page 8
Information GEORGIA GA RTC Laurel Heights UHS Laurel Heights L.P. 934 Briarcliff Road NE Atlanta, GA 30306 Phone: (404) 888-7860 EIN: 233045288 14-18 34 09/14/2010 09/14/2010 GA RTC Ramsey Youth Services of Georgia, Inc., d/b/a acon Behavioral Health System 3500 Riverside Drive acon, GA 310 Phone: (478) 477-3829 EIN: 352174803 Child & 3rd loor Ages: 7-21 38 11/15/20 11/15/20 GA SUDR Recovery Place, Inc. Recovery Place, Inc. 835 East 65th Street Savannah, GA 31405 Phone: (9) 355-1440 EIN: 570864414 Adult ull Day Adult Half Day onday-riday onday-riday 20 20 11/05/2003 11/05/2003 11/19/2010 11/19/2010 Page 9
Information GEORGIA GA PHP Talbott Columbus 00 Brookstone Centre Parkway Suite 210 Columbus, GA 31904 Phone: (706) 341-3600 EIN: 233044968 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. 4685 Dorsett Shoals Road Douglasville, GA 30135 Phone: (901) 251-4930 EIN: 581716970 20 04/30/1997 11/29/20 HAWAII HI RTC Kahi ohala Behavioral Health Sutter Health Pacific 91-2301 ort Weaver Road Ewa Beach, HI 96706 Phone: (808) 671-8511 EIN: 990298651 Child & 16 8 09/16/1999 09/06/2011 Page 10
Information HAWAII HI RTC The Queen s edical Center/ amily Treatment Center The Queen's edical Center 1301 Punchbowl Honolulu, HI 96813 Phone: (808) 538-9011 EIN: 990073524 Unit East Child 16 4 04/08/2003 04/08/2003 10/22/2010 10/22/2010 IDAHO ID RTC Eastern Idaho Regional edical Center - Behavioral Health Center Eastern Idaho Health Services, Inc. 2280 East 25th Street Idaho alls, ID 83404 Phone: (208) 227-2100 EIN: 820436622 RTC 22 10/19/2009 1/14/2013 Page 11
Information INDIANA IN RTC ichiana Behavioral Health Center HHC Indiana, Inc. 1800 North Oak Road Plymouth, IN 46563 Phone: (574) 936-3784 EIN: 200768028 Child/ 29 08/16/2004 11/09/2009 IN RTC Valle Vista Health System Valle Vista Hospital, LLC. 898 East ain Street Greenwood, IN 46143 Phone: (317) 887-1348 EIN: 621740366 Ages -18 Ages -18 24 18 04/16/2004 04/16/2004 01/16/2013 01/16/2013 KANSAS KS RTC KVC Hospitals, Inc. Prarie Ridge Psychiatric Hospital 4300 Brenner Drive Kansas City, KS 66104 Phone: 913-334-0294 EIN: 271672159 Ages 6-18 3/14/20 3/14/20 Page
Information KENTUCKY KY RTC The Brook Hospitals - Dupont TBD Acquisition, LLC. 1405 Browns Lane Louisville, KY 40207 Phone: (502) 896-0495 EIN: 205048087 Child Ages 5-20 06/02/2008 10//2011 KY RTC The Brook Hospitals - KI KI Acquisition 8521 LaGrange Road Louisville, KY 40242 Phone: (502) 426-6380 EIN: 205048153 Ages 13-17 Ages 13-17 18 24 06/8/2008 06/08/2008 10//2011 10//2011 KY RTC Spring eadows Center d/b/a Spring eadows 330 Hope Street ount Washington, KY 40047 Phone: (502) 538-00 EIN: 61-0597273 Ages -18 10 02//2013 02//2013 Page 13
Information ARYLAND D RTC Adventist Healthcare, Inc Adventist Behavioral Health 14901 Broschart Road Rockville, D 20850 Phone: (301) 251-4500 EIN: 521532556 Ages 14-17 1/2 Ages 14-17 1/2 7 7 09/06/2011 09/06/2011 09/06/2011 09/06/2011 ISSOURI O RTC Crittenton Children s Center Crittenton Center 10918 Elm Avenue Kansas City, O 64134 Phone: (816) 765-6600 EIN: 440545808 Ages 13-18 8 01/08/2009 07/14/2010 O RTC Heartland Behavioral Health Services, Inc. Great Plains Hospital, Inc. 1500 West Ashland Nevada, O 64772 Phone: (417) 667-2666 EIN: 431328523 Specialized Boys/Girls 36 08/15/2005 03/11/2010 Page 14
Information ISSOURI O RTC Lakeland Regional Hospital Lakeland Hospital Acquisition Corporation 440 South arket Avenue Springfield, O 65806 Phone: (417) 865-5581 EIN: 582291915 2 Northeast Girls RTC 2 North Boys RTC 18 10/8/2007 6/30/2009 ONTANA T RTC Shodair Children s Hospital ontana Children's Home & Hospital 2755 Colonial Drive Helena, T 59601 Phone: (406) 444-7500 EIN: 810231789 Child 24 20 20 8/25/2003 5//2009 T RTC ACADIA ONTANA 55 Basin Creek Road Butte, T 59701 Phone: 800-477-1067 EIN: 621681724 Child Ages 10-15 14 5/24/20 5/24/20 Page 15
Information NEVEDA NV RTC Willow Springs Center Willow Springs, LLC 690 Edison Way Reno, NV 89502 Phone: (775) 858-3303 EIN: 621814471 Child 50 52 14 05/08/1990 05/08/1990 05/08/1990 07/16/2010 07/16/2010 07/16/2010 NEW EXICO N RTC esilla Valley Hospital BHC esilla Valley Hospital, LLC 3751 Del Rey Boulevard Las Cruces, N 880 Phone: (800) 877-3500 EIN: 2026295 16 16 11/05/2004 11/05/2004 05/09/2011 05/09/2011 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) 352-3132 EIN: 742753620 (ages 5-17) emale (Ages 5-17) 10/24/20 10/24/20 10/24/20 10/24/20 Page 16
Information NORTH CAROLINA NC PHP Healthcare Solutions Network of North Carolina 170 Old Naples Road Hendersonville, NC 28792 Phone: (828) 684-4228 EIN: 205964230 Adult Half Day onday - riday 60 08/13/2009 11/11/2010 NC RTC Brynn arr Hospital Brynn arr Hospital 192 Village Drive Jacksonville, NC 28546 Phone: (910) 577-1400 EIN: 561317433 RTC 24 3/21/2007 8/24/2009 NC SUDR Wilmington Treatment Center Wilmington Treatment Center, Inc. 2520 Troy Drive Wilmington, NC 28401 Phone: (910) 762-2727 EIN: 541436102 Adult Inpatient Rehab/Detox Adult Sub Use ull Day (Ages 18-99) (Ages 18-99) onday- Sunday 44 88 05/05/2003 05/05/2003 /14/20 /14/20 Page 17
Information OHIO OH RTC Belmont Pines Hospital Belmont Pines Hospital 615 Churchill-Hubbard Road Youngstown, OH 44505 Phone: (330) 759-2700 EIN: 621658523 Child Ages 5-11 Ages -18 28 28 11/02/2009 11/02/2009 PENNSYLVANIA PA RTC KidsPeace National Centers, Inc. 5300 KidsPeace Drive Orefield, PA 18069-2044 Phone: 610-799-8343 EIN: 23-2654908 Ages 13-18 & 24 4/5/20 4/5/20 SOUTH CAROLINA SC RTC Palmetto Lowcountry Behavioral Health 2777 Speissegger Drive Charleston, SC 29405 Phone: (843) 747-5830 EIN: 571101380 RTC RTC 16 16 /07/2004 /07/2004 02/26/2010 02/26/2010 Page 18
Information SOUTH CAROLINA SC RTC Palmetto Pines (Summerville) Behavioral Health 225 idland Parkway Summerville, SC 29485 Phone: 843-851-5015 EIN: 570840074 Child/ RTC Ages: 7-21 60 8/9/20 8/9/20 SC RTC Three Rivers Residential Treatment - idlands Campus 200 Ermine Road West Columbia, SC 29170 Phone: (803) 791-9918 EIN: 570884924 KEYS Unit Ages - 20 1/2 KARS Child Unit Ages 6-15 01/26/2006 8//2011 11/5/2011 11/5/2011 SC PHP Three Rivers Residential Treatment - idlands Campus 200 Ermine Road West Columbia, SC 29170 Phone: (803) 791-9918 EIN: 570884924 Pathways Partial 1 pm to 7 pm ull Day 20 04/22/2013 4/22/2013 Page 19
Information SOUTH CAROLINA SC SUDR Earle E. orris Jr. Alcohol & Drug Addiction Treatment 610 aison Drive Columbia, SC 29203 Phone: (803) 935-7103 EIN: 576000922 Adult Detox Adult Inpatient Rehabilitation Adult Inpatient Rehabilitation 24 04/27/1993 04/27/1993 04/27/1993 06/03/2009 06/03/2009 06/03/2009 Dual Diagnosis Inpatient Rehab/Detox 04/27/1993 06/03/2009 TENNESSEE TN RTC Compass Intervention Center Keystone emphis, LLC 7900 Lowrance Road emphis, TN 385 Phone: (901) 758-2002 EIN: 621837606 Child 64 24 06/10/2003 06/10/2003 08/13/2009 08/13/2009 Page 20
Information TENNESSEE TN SUDR Bradford Health Services - Clarksville 235 A Dunbar Cave Road Clarksville, TN 37043 Phone: (931) 542-9816 EIN: 631198286 Adult Evening Sub Use Half Day Adult ull Day Adult ull Day All s: onday- Thursday, Saturday 20 10 20 4/30/2003 1/23/2009 Evening Sub Use Half Day 10 TEXAS TX RTC Cedar Crest Hospital and RTC HTH Cedar Crest, LLC 3500 South IOH-35 Belton, TX 76513 Phone: (254) 939-2100 EIN: 201915868 Ages -17 24 07/01/2008 03/31/2010 Page 21
Information TEXAS TX RTC Laurel Ridge Treatment Center Texas Laurel Ridge Hospital 17720 Corporate Woods Drive San Antonio, TX 78259 Phone: (800) 624-7975 EIN: 432002326 Child 20 20 01/01/1968 01/01/1968 11/30/2011 11/30/2011 TX RTC eridell Achievement Center 550 West Hwy 29 Liberty Hill, TX 78642 Phone: (800) 366-8656 EIN: 741655289 RTC & 64 16 16 16 22 10/10/1968 10/10/1968 10/10/1968 10/10/1968 10/10/1968 03/18/2009 03/18/2009 03/18/2009 03/18/2009 03/18/2009 TX RTC San arcos Treatment Center 0 Bert Brown Road San arcos, TX 78666 Phone: (615) 3-5700 EIN: 432002231 Child/ Child/ Child/ 28 24 21 01/01/1968 01/01/1968 01/01/1968 07/01/2010 07/01/2010 07/01/2010 Child/ 15 01/01/1968 07/01/2010 Page 22
Information TEXAS TX RTC Southwest ental Health Center 8535 Tom Slick Drive San Antonio, TX 78229 Phone: (210) 616-0300 EIN: 741153067 Child/ 52 02/22/1983 /05/2008 TX PHP El Paso Psychiatric Assoc. PA Alternative Centre 7760 Alabama Street El Paso, TX 79904 Phone: (915) 757-7999 EIN: 742726933 Adult Sub Use ull Day Adult Sub Use Half Day Sub Use Half Day onday - riday onday - riday onday - riday 16 47 03/03/2011 03/03/2011 03/03/2011 03/03/2011 03/03/2011 03/03/2011 TX SUDR Red River Recovery Center Red River Recovery, LLC 2501 Taylor Street Wichita alls, TX 76309 Phone: (940) 761-3034 EIN: 260269878 Adult Sub Use ull Day 7 days 18 02/05/2007 05/17/2010 Page 23
Information TEXAS TX SUDR Starlite Recovery Center 230 esa Verde Drive - East P.O. Box 317 Center Point, TX 78010 Phone: (830) 634-22 EIN: 770411689 Adult Detoxification Unit Adult Inpatient Rehabilitation ull Day 14 32 25 06/17/2011 06/17/2011 06/17/2011 06/17/2011 06/17/2011 06/17/2011 Adult Substance Use Partial Hospitalization Inpatient Rehabilitation ull Day 10 6 06/17/2011 06/17/2011 06/17/2011 06/17/2011 Substance Use PHP Page 24
Information UTAH UT RTC Center for Change UHS of Timpanogos 1790 North Street Orem, UT 84057 Phone: (801) 224-8255 EIN: 203687800 RTC 24 /24/2010 /24/2010 UT RTC Provo Canyon School UHS of Provo Canyon, Inc. 4501 North University Avenue Provo, UT 84604 Phone: (801) 227-2000 EIN: 233044423 Intensive Diagnostic & Stabilization Unit (Ages 13-18) ale 08/11/2010 08/11/2010 UT RTC Provo Canyon School UHS of Provo Canyon, Inc. 1350 East 750 North Orem, UT 84097 Phone: (801) 227-2100 EIN: 233044423 RTC 48 02/09/2011 02/09/2011 Page 25
Information VIRGINIA VA RTC Keystone Newport News, LLC 17579 Warwick Boulevard Newport News, VA 23603 Phone: (757) 888-0400 EIN: 320066225 Ages 11-21 24 06/09/2010 06/13/20 VA RTC Harbor Point Behavioral Health Center 301 ort Lane Portsmouth, VA 23704 Phone: 757-393-0061 EIN: 541465094 Ages 13-20 Ages 13-20 14 20 05/07/20 05/07/20 /07/20 /07/20 Gen Psych Ages 13-20 /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 23805 Phone: (804) 733-6874 EIN: 200959684 Ages 11-17 Ages 11-17 Page 26 36 36 6/24/1993 6/18/2010
Information VIRGINIA VA RTC Riverside Behavioral Health Center 2244 Executive Drive Hampton, VA 23666 Phone: (757) 827-1001 EIN: 541979321 Ages 13-18 Ages 13-18 28 20 1/8/2010 01/08/2010 07/25/20 07/25/20 VA RTC The Kempsville Center for Behavioral Health 860 Kempsville Road Norfolk, VA 23502 Phone: (757) 461-4565 EIN: 541465094 (Ages 11-17) (Ages 11-17) emale ale 22 11/27/2000 11/27/2000 03/06/20 03/06/20 VA RTC Hallmark Youthcare - Richmond 800 West Creek Parkway Richmond, VA 23238 Phone: (804) 784-2200 EIN: 582156548 Boys RTC 42 03/03/2011 03/03/2011 Page 27
Information VIRGINIA VA SUDR Life Center of Galax 1 Painter Street Galax, VA 24333 Phone: (276) 236-2994 EIN: 541436056 Adult Detox/Rehab Adult ull Day onday- Sunday 50 53 08/25/2010 08/25/2010 08/25/2010 08/25/2010 VA RTC North Spring Behavioral Healthcare 42009 Victory Lane Leesburg, VA 20176 Phone: 703-777-0800 EIN: 2015130 (Ages 13-17) 16 3/8/20 3/8/20 VA RTC Cumberland Hospital for Children and s 9407 Cumberland Road New Kent, VA 234 Phone: (804) 966-1636 EIN: 020567575 Ages 13-21 Ages 13-21 8 8 09/27/2011 09/27/2011 Page 28
Information VIRGINIA VA SUDR Williamsburg Place/The arley Center Diamond Healthcare of Williamsburg Inc. 5477 oorestown Road Williamsburg, VA 23188 Phone: (757) 565-0106 EIN: 541416559 Adult Detox Adult Inpatient Rehabilitation Adult Sub Use ull Day Adult Sub Use ull Day onday - riday Sunday - Saturday 24 24 30 24 01/13/2011 01/13/2011 01/13/2011 01/13/2011 01/13/2011 01/13/2011 01/13/2011 01/13/2011 VA RTC The Barry Robinson Center 443 Kempsville Road Norfolk, VA 23502 Phone: (757) 455-6100 EIN: 541038721 Children's RTC (Ages 6-13) 24 1/24/2013 1/24/2013 Page 29
Information WASHINGTON WA RTC Tamarack Center 2901 West ort George Wright Drive Spokane, WA 99224 Phone: (509) 326-8100 EIN: 9116841 16 /22/1995 /24/2010 Page 30