21_Attachment_J-11_Behavioral_Health_Facility_List.docx
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T R I C A R E •
December 10, 2014
To Whom It May Concern:
Attached is the TRICARE Mental Health Facility Certification List of Freestanding Psychiatric Partial Hospitalization Programs (PHPs), Residential Treatment Centers (RTCs) and Freestanding Substance Use Disorder Rehabilitation Facilities (SUDRFs). The following table lists status changes, which occurred through December 10,2014:
| Facility Name d/b/a |
| Change |
| Facility |
Type
| State |
| Effective Date |
University Behavioral,LLC d/b/a University Behavioral Center 2500 Discovery Drive Orlando, FL 32826 Phone: 407-281-7000
EIN: 205202458
PROGRAM CORRECTION TO:
Adolescent Female Ages 12-17
Adolescent Male Ages 13-17
| RTC |
| FL |
| 10/10/2014 |
Provo Canyon School UHS of Provo Canyon,Inc.
1350 East 750 North Orem, UT 84097 Phone: (801) 227-2100
EIN: 233044423
VOLUNTARY WITHDRAWAL FROM TRICARE
Female Capacity: 48
| RTC |
| UT |
| 10/21/2014 |
The Friary The Friary of Lakeview 4400 Hickory Shores Blvd Gulf Breeze, FL 32563 Phone: (850) 932-9375
EIN: 590737872
PROGRAM
RE-CERTIFICATION APPROVED
| SUDRF |
| FL |
| 10/31/2014 |
Millcreek Of Pontotoc 1814 Highway 15 North Pontotoc, MS 38863 Phone: 662-488-8878
EIN#: 640568382
VOLUNTARY WITHDRAWAL FROM TRICARE
Adolescent RTC Male-Female Ages 9-17 Capacity: 18
| RTC |
| MS |
| 11/1/2014 |
Timberline Knolls TK Behavioral, LLC 40 Timberline Drive Lemont, IL 60439 Phone: (630) 257-9600 NEW PROGRAM Female Adult Ages 18-65 Capacity: 14
| SUDRF |
| IL |
| 11/10/2014 |
Section J, Attachment J-11 Behavioral Health Facility List
TQMC HT9402-15-R-0005 Section J, Attachment J-11 Page 36 of 36
TRICARE
| Facility Name d/b/a |
| Change |
| Facility |
Type
| State |
| Effective Date |
EIN#: 32-0383042
Palmetto Pines (Summerville) Behavioral Health 225 Midland Parkway Summerville, SC 29485 Phone: 843-851-5015
EIN: 570840074
PROGRAM
RE-CERTIFICATION APPROVED
| RTC |
| sc |
| 11/11/2014 |
Hallmark Youthcare- Richmond 12800 West Creek Parkway Richmond, VA 23238 Phone: (804) 784-2200
EIN: 582156548
VOLUNTARY WITHDRAWAL Adolescent Male Ages 11-17 Capacity: 42
| RTC |
| VA |
| 11/20/2014 |
Monthly Mental Health Facility Listing Report
As of December 10, 2014
TABLE OF CONTENTS
| LISTING OF MENTAL HEALTH FACILITIES CERTIFIED BY TRICARE Alabama....................................................................................................................................... | 1 |
| Alaska........................................................................................................................................... | 2 |
| Arizona......................................................................................................................................... | 3 |
| Arkansas................................................................................................................................. | 3 |
| California ...................................................................................................................................... | 4 |
| Colorado................................................................................................................................. | 4 |
| Connecticut.................................................................................................................................. | 5 |
| Florida........................................................................................................................................... | 5 |
| Georgia................................................................................................................................... | 7 |
| Hawaii..................................................................................................................................... | 9 |
| Idaho.............................................................................................................................................. | 10 |
| Illinois ............................................................................................................................................. | 10 |
| Indiana........................................................................................................................................... | 10 |
| Kansas........................................................................................................................................... | 11 |
| Kentucky....................................................................................................................................... | 12 |
| Louisiana ....................................................................................................................................... | 12 |
| Maryland......................................................................................................................................... | 13 |
| Missouri ........................................................................................................................................ | 13 |
| Montana....................................................................................................................................... | 14 |
| Nevada.................................................................................................................................. | 14 |
| New Mexico ......................................................................................................................... | 15 |
| North Carolina ......................................................................................................................... | 15 |
| Ohio............................................................................................................................................... | 17 |
| Pennsylvania................................................................................................................................. | 17 |
| South Carolina.............................................................................................................................. | 17 |
| Tennessee ..................................................................................................................................... | 19 |
| Texas.............................................................................................................................................. | 20 |
| Utah................................................................................................................................................ | 23 |
| Virginia ........................................................................................................................................... | 24 |
| Washington .................................................................................................................................. | 28 |
| Appendix A-Glossary of Acronyms and Terms | A1 |
MENTAL HEALTH FACILITY CERTIFICATION LISTING
State Facility Type {RTCDoily Per-Diem
Facility Information
Description of Papulation Served or Program
Gender
Days of Operation
Patient Bed Capacity
Initial Certification Date
Most Recent Recertification Dote
ALABAMA
| AL |
| SUDRF |
| Bradford Health Services - Huntsville |
SSS Sparkman Drive, Suite 208 Huntsville, AL 3S816 Phone: (2S6) 89S-3848
EIN: 631198286
Adult Evening Sub Use Half Day
Adolescent Evening Use Half Day
Adult Mid Day
Adult Morning M&F M&F
M&F M&F Monday- Thursday
Monday- Thursday
Monday- Thursday
Monday- Thursday
10/07/2002
10/07/2002
07/23/2013
07/23/2013
| AL |
| SUDRF |
| Bradford Health Services- Huntsville Lodge |
1600 Browns Ferry Road Madison, AL 3S7S8 Phone: (2S6) 461-7272
EIN: 631198286
Adolescent/Adult Inpatient Rehab Ages 14-18
Adult Inpatient Rehab/Detox
Adult Sub Use Full Day
Adolescent Sub Use Full Day M&F
M&F M&F M&F 24/7
24/7
Monday- Sunday
11/29/1993
11/29/1993
04/03/2013
04/03/2013
Section J, Attachment J-11 Behavioral Health Facility List
Facility Type (RTCDaily Per-Diem
Description aj Papulation
GMder
Operation
Patient Bed Capacity
Initial Certijicatian Date
Most Recent Recertijicatian Date
ALABAMA
| Al |
| SUDRF |
| Bradford Health Services- Pensacola |
8333 North Davis Highway Pensacola, Fl32S14 850-308-7720
EIN: 631198286
| Adult Evening · Half Day Partial Ages 19+ |
| M&F |
| Monday- Thursday (5:30pm · 9:30 pm) |
| 1S |
| 3/4/2014 |
| 3/4/2014 |
| Al |
| SUDRF |
| 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 Full Day Adult Sub Use Full Day M&F M&F
M&F 24/7
Monday- Saturday
02/04/1993
02/04/1993
02/04/1993 03/04/2014
03/04/2014
03/04/2014
ALASKA
| AK |
| RTC |
| DeBarr Residential Treatment |
Center Frontline Hospital, LLC 1500 DeBarr Circle Anchorage, AK 99508 Phone: (907) 258-7575
EIN: 721539254
Adolescent Ages 6-18
| M&F |
| 24/7 |
| 60 |
| 07/16/2008 |
| 06/26/2013 |
Facility Type (RTCDaiiy Per-Diem
Description of Population
Operation
Patient Bed Capacity
Initial Certification Date
MastRecl!nt Recertification Dote
ARIZONA
AZ
RTC
Oasis Behavioral Health Southwest Children's Health Services dba Formerly Pare Place 2190 North Grace Boulevard Chandler, AZ 85225 Phone: 408-917-9301
EIN #: 860768611
Adolescent Ages 11-15
Adolescent Ages 15-17
Adolescent Ages 11-17
Adolescent Ages 11-17 M M F F
01/17/2012
ARKANSAS
AR
RTC
BHC Pinnacle Pointe Hospital 11501Financial Center Parkway little Rock, AR 72211 Phone: (SOl) 223-3322
EIN: 621658502
CITC- Male-Female Ages 5-12
AITC- Male Ages 12-17
AITC - Female Ages 12-17 M&F M
07/22/1994
07/22/1994 08/26/2012
AR
RTC
Habilitation Center,Inc.,d/b/a Millcreek of Arkansas 1810 Industrial Drive Fordyce, AR 71742 Phone: 870-352-8203
EIN: 742474097
Adolescent Ages 12-18
Adolescent Ages 12-18 M F
10/10/2014 10/10/2014
Facility Type {RTCDaily
Operation
Patient Bed Capacity
Initial Certification Dote
CALIFORNIA
| CA |
| SUDRF |
| Lasting Recovery |
Farkas & Saalinger Psychological Corp 6046 Cornerstone Ct W. #13 San Diego, CA 92121 Phone: (858) 453-4315
EIN: 202291188
Adult Sub Use Full Day
18-65
| M&F | |
| Monday-Friday | |
| 32 | |
| OS/07/2010 | 07/11/2013 |
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
Mountain View Place- Child Ages 5-12
Mountain View Place - Adolescent Ages 12-18
Connections Reactive Attachment Unit Ages 5-12 M&F
M&F
24/7
10/19/1990
10/19/1990
08/07/2012 8/07/2012
Facility Type (RTCDaily Per-Diem
Operation
Patient Bed Capacity
Initial Ct!rtljicatlon Date
Most Recent Recertification Date
CONNECTICUT
CT
SUDRF
Stonington Institute Adult Full Day Stonington Behavioral Health, Inc.
75 Swanton Hili Road North Stonington,CT 06359 Adult Inpatient Phone: (860) 439-6005 Rehabilitation EIN: 200687971 Detox/lnpt. Rehab M&F Monday-Friday
24/7 M&F
24/7
01/28/2010
01/24/2013
01/24/2013
01/23/2013
A
FLORID
FL
RTC
LaAmistad Behavioral Health Services LaAmistad Behavioral Health Services 1650 Park Avenue North Maitland, FL 32751 Phone: (407) 647-0660
EIN: 581791069
Adolescent Ages 12-18
Child Ages 5-11 M &F M&F
7/23/1999
7/23/1999 5/28/2014
5/28/2014
FL
RTC
Palm Shores Behavioral Health Center (Formerly Manatee Palms Youth Services) (Premier Behavioral5oiutions of Florida, Inc.)
1324 37th Avenue East Bradenton, FL 34208 Phone: (941) 792-2222
EIN: 650816927
Child Ages 5-12
Adolescent Ages 13-17
Adolescent Ages 13-17
Adolescent 13-17 M&F M
5/29/2009
10/1/2013
Facility Type
Served ar Program
Daysaf Operation
Patient Bed Capacity
Initial Certification Date
Most Recent Recertification Date
FLORID
A Fl
RTC
National Deaf Academy 19650 U.S. Highway 441 Mt. Dora, Fl32757 Phone: (352) 735-9SOO EIN: 593653865 Child/ Adolescent Bldg Ages 11-17
Adult Building 7 Ages 18-21
9/13/2011
9/13/2011 3/18/2013
3/18/2013 Fl
SUDRF
The Friary The Friary of lakeview 4400 Hickory Shores Blvd Gulf Breeze, Fl32563 Phone: (850) 932-9375
EIN: 590737872
Adult Detox
Adult Inpatient Rehabilitation
Adult Sub Use Partial- Full Day M&F M&F
M&F
Monday- Saturday
19/17/1993 10/31/2014 Fl
SUDRF
Twelve Oaks Alcohol & Drug Treatment Center Bowling Green Inn of Pensacola 2068 Healthcare Avenue Navarre, FL 32566 Phone: (850) 939-1200
EIN: 581795523
Adult Detox/Rehab
Adult Sub Use Full Day
Adolescent Sub Use Full Day M&F M&F
M&F 24/7
Monday- Sunday
Monday- Sunday
07/19/1993
11/01/2012
Fl
RTC
University Behavioral,LLC d/b/a University Behavioral Center 2500 Discovery Drive Orlando, Fl32826 Phone: 407-281-7000
EIN: 205202458
Adolescent Ages 12-17
Adolescent
Female
Male
4/3/2012 4/3/2012
Facility Type
Operation
Patient Bed Capacity
Initial
GEORGIA
| GA |
| SUDRF |
| Bradford Health Services- Augusta |
105 Rossmore Place Augusta, GA 30909 Phone: (706) 854-1126
EIN: 631198286
Adolescent/Adult Sub Use Half Day
Adult Evening Sub Use Half Day M&F
Monday- Thursday, Saturday
10/05/2005
10/05/2005 06/26/2013
06/26/2013
| GA |
| SUDRF |
| 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
Adolescent Evening Sub Use Half Day M&F
Monday- Thursday
12/27/2007
12/27/2007 4/25/2013
4/25/2013
| GA |
| RTC |
| Coastal Harbor Treatment Center |
UHS of Savannah, LLC 1150 Cornell Avenue Savannah, GA 31406 Phone: (912) 354-3911
EIN: 200931196
Two East Ages 13-17
Two North Ages 9-13 Female
24/7
| 1/18/2008 |
| 2/15/2012 |
| GA |
| RTC |
| Laurel Heights |
UHS Laurel Heights L.P.
934 Briarcliff Road NE Atlanta, GA 30306 Phone: (404) 888-7860
EIN: 233045288
Adolescent Ages 13-20 M
| 24/7 |
| 17 |
| 09/14/2010 |
| 11/26/2013 |
Facility Type (RTCDol/y Per-Diem
Operation
Patient Bed Capacity
Initio/ Certification Dote
GEORGIA
| GA |
| RTC |
| Ramsey Youth Services of |
Georgia, Inc., d/b/a Macon Behavioral Health System 3500 Riverside Drive Macon, GA 31210 Phone: (478} 477-3829
EIN: 352174803
Child & Adolescent Ages 7-21
| M&F |
| 24/7 |
| 38 |
| 11/15/2012 |
| 11/15/2012 |
| GA |
| SUDRF |
| Recovery Place,Inc. Recovery Place,Inc. |
835 East 65th Street Savannah, GA 31405 Phone: (912} 355-1440
EIN: 570864414
Adult Half Day
Adult Full Day M&F
Monday-Friday
Monday-Friday
11/05/2003
11/05/2003 11/19/2010
11/19/2010
| GA |
| SUDRF |
| Talbott Columbus |
1200 Brookstone Centre Parkway Suite 210 Columbus, GA 31904 Phone: (706} 341-3600
EIN: 233044968
Adult Substance Use Partial- Full Day Ages18-80
Adult Substance Use Partial- Half Day Ages18-80
Adolescent Half Day Substance Use Ages13-17 M&F
| Monday-Friday Monday-Friday Monday-Fricay |
| 12 |
02/02/2012
02/02/2012
05/16/2014 05/16/2014
Facility Type
Description af Papulation
Operation
Patient Bed Capacity
Initial
Mast Recent Recertification Date
GEORGIA
| GA |
| RTC |
| Youth Villages |
Youth Villages,Inc.
4685 Dorsett Shoals Road Douglasville, GA 30135 Phone: (901) 251-4930
EIN: 581716970
| Adolescent |
| M&F |
| 24/7 |
| 40 |
| 04/30/1997 |
| 4/26/2013 |
HAWAII
| HI |
| RTC |
| KahiMahala Behavioral Health |
Sutter Health Pacific 91-2301Fort Weaver Road Ewa Beach, HI 96706 Phone: (808) 671-8511
EIN: 990298651
Adolescent
Child
| M&F M&F |
| 24/7 |
24/7
| 09/16/1999 |
| 09/06/2011 |
| HI |
| RTC |
| The Queen's Medical Center/ Family Treatment Center |
The Queen's Medical Center 1301Punchbowl Honolulu, HI 96813 Phone: (808) 538-9011
EIN: 990073524
Adolescent Unit East
Child
| M&F M&F |
| 24/7 |
04/08/2003
04/08/2003 10/22/2013
10/22/2013
Facility Type (RTCDaily Per-Diem
Operation
Patient Bed Capacity
Initial Certification Date
Rote
IDAHO
| 10 |
| RTC |
| Eastern Idaho Regional Medical Center - Behavioral Health Center Eastern Idaho Health Services, Inc. |
2280 East 25th Street Idaho Falls, 10 83404 Phone: (208) 227-2100
EIN: 820436622
| RTC | |
| M&F | |
| 24/7 | |
| 22 | |
| 10/19/2009 | 11/06/2013 |
ILLINOIS
| ll |
| RTC |
| Timberline Knolls |
TK Behavioral, LLC 40 Timberline Drive Lemont, IL 60439 Phone: (630) 257-9600
EIN#: 32-0383042
Adolescent Ages 12-20
| F |
| 24/7 |
| 35 |
| 2/25/2014 |
| 2/25/2014 |
| ll |
| SUDRF |
| Timberline Knolls |
TK Behavioral, LLC 40 Timberline Drive Lemont, IL60439 Phone: (630) 257-9600
EIN#: 32-0383042
Adult Ages 18-65 F
| 24/7 |
| 14 |
| 11/10/2014 |
| 11/10/2014 |
Facility Type (RTCDaily Per-Diem
Operation
Patient Bed Capacity
Initial
| INDIAN |
| A |
| IN |
| RTC |
| Michiana Behavioral Health |
Center HHC Indiana, Inc.
1800 North Oak Road Plymouth, IN 46563 Phone: (574) 936-3784
EIN: 200768028
Child/Adolescent Ages 6-18
| M&F |
| 24/7 |
| 29 |
| 08/16/2004 |
| 07/09/2013 |
| IN |
| RTC |
| Midwest Center for Youth and |
Families South Shore Academy 1012 W. Indiana Street Kouts, IN 46347 219-766-2999
EIN: 23-2985289
Adolescent Ages 12-20
| Female |
| 24/7 |
| 15 |
| 08/22/2013 |
| 08/22/2013 |
| IN |
| RTC |
| Valle Vista Health System |
Valle Vista Hospital, LLC.
898 East Main Street Greenwood, IN 46143 Phone: (317) 887-1348
EIN: 621740366
Adolescent Ages 12-18
Adolescent Ages 12-18 M
24/7
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
Adolescent Ages 6-18 M&F
| 24/7 |
| 12 |
| 3/14/2012 |
| 3/14/2012 |
Facility Type
Operation
Patient Bed Capacity
Initial
KENTUCKY
KY
United Healthcare of Hardin, Inc. d/b/a Lincoln Trail behavioral Health System 3909 South Wilson Road Radcliff, KY 40160 Phone: 270-351-9444
EIN: 62-1244469
Adolescent Ages 9-17 F 24/7 8/23/2013 8/23/2013
KY
RTC
The Brook Hospitals - Dupont TBD Acquisition, LLC.
1405 Browns Lane Louisville, KY 40207 Phone: (502) 896-0495
EIN: 205048087
Child Ages 5-12 M&F 24/7 06/02/2008 06/19/2013
KY
RTC
The Brook Hospitals - KMI KMI Acquisition 8521LaGrange Road Louisville, KY 40242 Phone: (502) 426-6380
EIN: 205048153
Adolescent Ages 13-17
Adolescent
M
06/8/2008
06/08/2008 06/19/2013
06/19/2013
LOUISAINA
LA
SUDRF
Addiction Recovery Resources, Inc.
4836 Wabash Metairie, LA 70001 Phone: (504) 780-2766
EIN: 264332101
Substance Use Partial Program
Ages 18+
D· 1 Monday to Friday 9 am to 8 pm 10/10/2013 10/10/2013
Facility Type (RTCDaily Per-Diem
S<!rved or Program
Operation
Patient Bed Capacity
Initial C<!rti/ication Date
MostRecl!nt Recertification Date
MARYLAND
| MD | ||
| RTC | ||
| Adventist Healthcare,Inc | Adolescent | |
| Adventist Behavioral Health | Ages 14- 17 1/2 |
14901Broschart Road
| Rockville, MD 20850 | Adolescent |
| Phone: (301) 251-4500 | Ages 14- 17 1/2 |
EIN: 521532556
| M | 24/7 | 7 | 09/06/2011 |
| 10/22/2013 |
10/22/2013
09/06/2011
MISSOURI
| MO |
| RTC |
| Crittenton Children's Center |
Crittenton Center 10918 Elm Avenue Kansas City, MO 64134 Phone:(816)765-6600
EIN: 440545808
Adolescent Ages 13-18
| M&F |
| 24/7 |
| 13 |
| 01/08/2009 |
| 07/31/2014 |
| MO |
| RTC |
| Heartland Behavioral Health |
Services,Inc.
Great Plains Hospital, Inc.
1500 West Ashland Nevada, MO 64772 Phone: (417) 667-2666
EIN: 431328523
| Specialized Adolescent Boys/Girls |
| M&F |
| 24/7 |
| 36 |
| 08/15/2005 |
| 03/11/2010 |
| MO |
| RTC |
| Lakeland Regional Hospital Lakeland Hospital Acquisition Corporation |
440 South Market Avenue Springfield, MO 65806 Phone: (417) 865-5581
EIN: 582291915
Adolescent 2 North and Northeast Units M&F
| 24/7 |
| 17-Apr |
| 10/8/2007 |
| 9/19/2013 |
Facility Type (RTCDoily Per-Diem
Setved or Program
Operation
Patient Bed Capacity
Initial
MONTANA
MT
Shodair Children's Hospital Montana Children's Home & Hospital 2755 Colonial Drive Helena, MT 59601 Phone: (406) 444-7500
EIN: 810231789
| Adolescent Adolescent Child |
| M&F M&F M&F |
| 24/7 |
24/7
24/7
8/25/2003
8/25/2003
8/25/2003 10/24/2013
10/24/2013
10/24/2013
| MT |
| RTC |
| ACADIA MONTANA |
55 Basin Creek Road Butte, MT 59701 Phone: 800-477-1067
EIN: 621681724
Child Ages 10-15
| M&F |
| 24/7 |
| 14 |
| 5/24/2012 |
| 5/24/2012 |
NEVEDA
| NV |
| RTC |
| Willow Springs Center |
Willow Springs, LLC 690 Edison Way Reno, NV 89502 Phone: (775) 858-3303
EIN: 621814471
| Adolescent Adolescent Child |
| M F M&F |
| 24/7 |
24/7
24/7 so
05/08/1990
05/08/1990
05/08/1990 04/26/2013
04/26/2013
04/26/2013
Facility Type (RTCDally Per-Diem
Operation
Patient Bed Capacity
Initial Certification Date
Most Recent Recertification Date
NEW MEXICO
NM
RTC
Mesilla Valley Hospital BHC Mesilla Valley Hospital,LLC 3751Del Rey Boulevard Las Cruces, NM 88012 Phone: (800) 877-3500
EIN: 202612295
Adolescent
Adolescent M F 24/7
24/7
11/05/2004
11/05/2004 05/09/2011
05/09/2011
NM
RTC
Desert Hills Youth and Family Centered Services of New Mexico, Inc., d/b/a Desert Hills 5310 Sequoia NW Albuquerque, NM 87120 Phone: (505) 352-3132
EIN: 742753620
Adolescent Child Adolescent Adolescent Adolescent M&F Female Male Male Female 24/7
24/7
24/7
24/7
24/7
10/24/2012
10/24/2012
10/24/2012
11/22/2013
11/22/2013 10/24/2012
10/24/2012
10/24/2012
11/22/2013
11/22/2013
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 M&F Monday- Friday 08/13/2009 11/11/2010
Facility Type (RTCDaily Per-Diem
Operation
Patient Bed Capacity
Initial Certification Date
R t
NORTH CAROLINA
NC
Brynn Marr Hospital Brynn Marr Hospital 192 Village Drive Jacksonville, NC 28546 Phone: (910) 577-1400
EIN: 561317433
Adolescent F 24/7 3/21/2007 7/12/2013
NC
RTC
SBH -Wilmington LLC d/b/a Strategic Behavioral Center- Wilmington 2050 Mercantile Drive Leland, NC 28451 910-371-2500
EIN: 20-8405354
Adolescent Ages 12-17 M&F 24/7 7/30/2013 7/30/2013
NC
SUDRF
Wilmington Treatment Center Wilmington Treatment Center, Inc.
2520 Troy Drive Wilmington, NC 28401 Phone: (910) 762-2727
EIN: 541436102
Adult Inpatient Rehab/Detox Ages 18-99
Adult Sub Use Full Day Ages 18-199
05/05/2003
05/05/2003 12/03/2013
12/03/2013
Facility Type (RTCDaily Per-Diem
Served ar Pragram
Days a/ Operation
Patient Bed Capacity
Initial
OHIO
| OH | |||||
| RTC | |||||
| Belmont Pines Hospital | Child | M&F | 24/7 | 28 | |
| Belmont Pines Hospital | Ages 5-11 |
615 Churchill-Hubbard Road
| Youngstown, OH 44505 | Adolescent | M&F | 24/7 | 28 |
| Phone: (330) 759-2700 | Ages 12-18 |
EIN: 621658523
11/02/2009 12/12/2013
PENNSYLVANIA
| PA |
| RTC |
| KidsPeace National Centers,Inc. |
5300 KidsPeace Drive Orefield, PA 18069-2044 Phone: 800-854-3123
EIN: 23-2654908
| Adolescent |
| M&F |
| 24/7 |
| 24 |
| 4/5/2012 |
| 12/19/2013 |
SOUTH CAROLINA
| sc |
| RTC |
| Palmetto Pines (Summerville) Behavioral Health |
225 Midland Parkway Summerville,SC 29485 Phone: 843-851-5015
EIN: 570840074
| Child/Adolescent RTC Ages 7-21 |
| M |
| 24/7 |
| 60 |
| 8/9/2012 |
| 11/11/2014 |
Facility Type (RTCDal/y Per-Diem
Operation
Patient Bed Capacity
Initial
SOUTH CAROLINA
| sc |
| RTC |
| Three Rivers Residential |
Treatment·Midlands Campus 200 Ermine Road West Columbia, SC 29170 Phone: {803) 791-9918
EIN: 570884924
KEYS Adolescent Unit Ages 10-18
KARS Child Unit Ages 6-11 M&F
24/7
01/26/2006
8/12/2011 8/6/2013
8/6/2013
| sc |
| SUDRF |
| Earle E.Morris Jr. Alcohol & Drug |
Addiction Treatment 610 Faison Drive Columbia,SC 29203 Phone: {803) 935-7103
EIN: 576000922
Adult Detox
Adult Inpatient Rehabilitation
Adult Inpatient Rehabilitation
Dual Diagnosis Inpatient Rehab/Detox M&F M
24/7
04/27/1993
04/27/1993
08/30/2013
08/30/2013
| sc |
| RTC |
| New Hope Carolinas,Inc. |
101Sedgewood Drive Rock Hill, SC 29732 Phone: {843) 572-3498
EIN: 571099555
Adolescent
Ages 12-20
| F |
| 24/7 |
| 36 |
| 02/12/2014 |
| 2/12/2014 |
Facility Type
Operation
Patient Bed Capacity
Initial
SOUTH CAROLINA
| sc |
| PHP |
| Three Rivers Residential |
Treatment- Midlands Campus 200 Ermine Road West Columbia, SC 29170 Phone: (803) 791- 9918
EIN: 570884924
Pathways Partial Program
| M&F |
| 1pm to 7 pm |
Full Day
| 20 |
| 04/22/2013 |
| 4/22/2013 |
| sc |
| RTC |
| SPRINGBROOK BEHAVIORAL HEALTH SYSTEM |
One Havenwood Lane Travelers Rest, SC 29690 Phone: 864-843-8013
EIN: 570693272
Adolescent Ages12-18
Child Ages 5-12
Adolescent Ages12-18
Adolescent Ages 12-18 M&F M&F M
24/7
03/26/2014
03/26/2014
03/26/2014
TENNESSEE
| TN |
| SUDRF |
| 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 Full Day Adult Full Day Adolescent Evening Sub Use Half Day M&F
M&F M&F M&F
| All Programs: Monday- Thursday, Saturday |
| 20 |
4/30/2003
4/30/2003
6/26/2013
6/26/2013
Facility Type (RTCDo/ly Per-Diem
Operation
Patient Bed Capacity
Initial
TENNESSEE
| TN |
| RTC |
| Compass Intervention Center |
Keystone Memphis, LLC 7900 Lowrance Road Memphis, TN 38125 Phone: (901) 758-2002
EIN: 621837606
Adolescent Ages 12-18
Child Ages 6-11
Adolescent Ages 12-18
| Female M&F Male |
| 24/7 |
07/26/2003
06/10/2003
07/26/2013 07/26/2013
| TN |
| RTC |
| Village Behavioral Health d/b/a The Village |
2431Jones Bend Road Louisville, TN 37777 Phone: (865) 970-1263
EIN: 270788813
Adolescent 13-17
Adolescent 13-17 Male
Female 24/7
TEXAS
| TX |
| RTC |
| Cedar Crest Hospital and RTC HMTH Cedar Crest, LLC |
3500 South IOH-35 Belton, TX 76513 Phone: (254) 939-2100
EIN: 201915868
Adolescent Ages 12-17
| M&F |
| 24/7 |
| 24 |
| 07/01/2008 |
| 05/28/2013 |
Facility Type (RTCDaily Per-Diem
Doysof Operation
Patient Bed Capacity
Initial
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
Adolescent
Child
| M&F M&F |
| 24/7 |
24/7
01/01/1968
01/01/1968 11/30/2012
11/30/2012
| TX |
| RTC |
| Meridell Achievement Center |
12550 West Hwy 29 liberty Hill, TX 78642 Phone: (800) 366-8656
EIN: 741655289
PSYCH RTC Ages 12-18
NEURO PSYCH RTC Ages 11-18
NURO PSYCH RTC Ages 14-18
NEURO PSYCH RTC Ages 12-18
CHILD NEURO PSYCH RTC
Ages 5-11
| M&F M&F M&F M&F M&F |
| 24/7 |
10/10/1968
10/10/1968
07/18/2013
07/18/2013
| TX |
| PHP |
| Mission Resiliency at Laurel |
Ridge 1900 East Elms Road, Suite 203 Killeen, TX 76542 Phone: (254) 781-4510
EIN: 432002326
Partial Hospitalization Program M&F
Ages:
18+ 8:00am to 3:00pm Monday - Friday
| 15 |
| 8/1/2014 |
| 8/1/2014 |
Facility Type
Operation
Patient Bed Capacity
Initial
TEXAS
| TX |
| RTC |
| San Marcos Treatment Center |
120 Bert Brown Road San Marcos, TX 78666 Phone: (615) 312-5700
EIN: 432002231
Child/Adolescent Child/Adolescent Child/Adolescent Child/Adolescent M&F M&F M&F M&F 24/7
24/7
24/7
24/7
01/01/1968
01/01/1968
01/01/1968
01/01/1968 03/04/2014
03/04/2014
03/04/2014
03/04/2014
| 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 Full Day
Adult Sub Use Half Day
Adolescent Sub Use Half Day
| M&F M&F M&F |
| Monday- Friday |
Monday- Friday
Monday- Friday
03/03/2011
03/03/2011
03/03/2011 07/28/2013
07/28/2013
07/28/2013
| TX |
| SUDRF |
| Red River Recovery Center |
Red River Recovery, LLC 2501Taylor Street Wichita Falls,TX 76309 Phone: (940) 761-3034
EIN: 260269878
| Adult Sub Use Full Day |
| M&F |
| 7 days |
| 18 |
| 02/05/2007 |
| 07/31/2013 |
Facility Type (RTCDoily Per-Diem
Operation
Patient Bed Capacity
Initial
TEXAS
| TX |
| SUDRF |
| Starlite Recovery Center |
230 Mesa Verde Drive - East P.O. Box 317 Center Point, TX 78010 Phone: (830) 634-2212
EIN: 770411689
Adult Detox Ages 18-65+
Adult Rehab/Res Ages 18-65+
Adult PHP- Full Day 18-65+
| M&F M&F M&F |
| 24/7 |
Full Day Monday- Friday
06/17/2011
06/17/2011
06/17/2011 07/26/2013
UTAH
| UT |
| RTC |
| Center for Change |
UHS ofTimpanogos 1790 North State Street Orem, UT 84057 Phone: (801) 224-8255
EIN: 203687800
| RTC |
| F |
| 24/7 |
| 24 |
| 12/24/2010 |
| 12/24/2010 |
| UT |
| RTC |
| Provo Canyon School |
UHS of Provo Canyon, Inc.
4S01North University Avenue Provo, UT 84604 Phone: (801) 227-2000
EIN: 233044423
| Intensive Diagnostic & Stabilization Unit Ages13-18 |
| Male |
| 24/7 |
| 12 |
| 08/11/2010 |
| 01/1S/2013 |
Facility Type (RTCDaily Per-Diem
Operation
Patient Bed Capacity
Initial
MastRec nt Recertification Date
VIRGINIA
| VA |
| RTC |
| Keystone Newport News,LLC |
17579 Warwick Boulevard Newport News, VA 23603 Phone: (757) 888-0400
EIN: 320066225
Adolescent Ages 11-21
| M&F |
| 24/7 |
| 24 |
| 06/09/2010 |
| 06/13/2012 |
| VA |
| RTC |
| Harbor Point Behavioral Health |
Center 301Fort lane Portsmouth, VA 23704 Phone: 757-393-0061
EIN: 541465094
Adolescent Ages 13-20
Adolescent Ages 13-20
Adolescent Gen Psych Ages 13-20
Child RTC Unit Ages 6-12 M F F
24/7
05/07/2012
05/07/2012
12/07/2012
12/07/2012
| VA |
| RTC |
| Poplar West |
HHC Poplar Springs, Inc.
350 Poplar Drive Petersburg, VA 23805 Phone:(804)733-6874
EIN: 200959684
Adolescent Ages 11-17
Adolescent Ages 11-17 M
24/7
| 6/24/1993 |
| 6/30/2012 |
6/30/2012
Facility Type (RTCDaily Per-Diem
Doysof Operation
Patient Bed Capacity
Initial
VIRGINIA
| VA |
| SUDRF |
| Phoenix Houses ofthe Mid- Atlantic,Inc. |
200 North Glebe Road,Suite 104 Arlington VA, 22203 Phone: 703-841-0703
EIN: 540805530
| Adult Substance Use Partial Hospitalization Program |
| M&F |
| Monday- Friday |
9:30am to 3:30pm
| 18 |
| 9/23/2014 |
| 9/23/2014 |
| VA |
| SUDRF |
| Phoenix Houses ofthe Mid- Atlantic,Inc. |
d/b/a The Boys Recovery Lodge 521North Quincy Street Arlington VA, 22203 Phone: 703-841-0703
EIN: 540805530
| Adolescent Substance Use Program Ages 14-17 |
| Male |
| 24/7 |
| 12 |
| 10/24/2014 |
| 10/24/2014 |
| VA |
| SUDRF |
| Phoenix Houses of the Mid- Atlantic,Inc. |
d/b/a The Girls Recovery Lodge 3100 Arlington Blvd Arlington VA, 22203 Phone: 703-841-0703
EIN: 540805530
Adolescent Substance Use Program Ages 13-18
| Female |
| 24/7 |
| 10 |
| 10/24/2014 |
| 10/24/2014 |
| VA |
| RTC |
| Riverside Behavioral Health |
Center 2244 Executive Drive Hampton, VA 23666 Phone: {757) 827-1001
EIN: 541979321
Adolescent Ages 13-18
Adolescent Ages 13-18
| F M |
| 24/7 |
1/8/2010
01/08/2010 07/25/2012
07/25/2012
Facility Type
Operation
Patient Bed Capacity
Initial
VIRGINIA
| VA |
| RTC |
| The Kempsville Center for |
Behavioral Health 860 Kempsville Road Norfolk,VA 23502 Phone: (757) 461-4565
EIN: 541465094
Adolescent Ages 11-17
Adolescent Ages11-17 Female
24/7
11/27/2000
11/27/2000 01/15/2013
01/15/2013
| VA |
| SUDRF |
| life Center of Galax |
112 Painter Street Galax, VA 24333 Phone: (276) 236-2994
EIN: 541436056
Adult Detox/Rehab Ages 18+
Adult Full Day Ages 18+ M&F
24/7
08/25/2010
08/25/2010 07/26/2013
| VA |
| RTC |
| North Spring Behavioral |
Healthcare 42009 Victory Lane Leesburg, VA 20176 Phone: 703-777-0800
EIN: 201215130
Adolescent Ages 13-17
| M |
| 24/7 |
| 16 |
| 3/8/2012 |
| 3/8/2012 |
| VA |
| RTC |
| Cumberland Hospital for Children and Adolescents |
9407 Cumberland Road New Kent, VA 23124 Phone: (804) 966-1636
EIN: 020567575
Adolescent Ages 13-21
Adolescent Ages 13-21
| M F |
| 24/7 |
09/27/2011
09/27/2011 12/02/2013
12/02/2013
Facility Type
Operation
Patient Bed Capacity
Initio/ Certification Date
VIRGINIA
| VA |
| SUDRF |
| Williamsburg Place/The Farley |
Center Diamond Healthcare of Williamsburg Inc.
5477 Moorestown Road Williamsburg, VA 23188 Phone: (757) 565-0106
EIN: 541416559
Adult Detox
Adult Inpatient Rehabilitation Adult Sub Use Full Day Adult Sub Use Full Day M&F M&F
24/7
Monday- Friday
Sunday- Saturday
01/13/2011
01/13/2011
02/13/2013
02/13/2013
| VA |
| RTC |
| The Barry Robinson Center |
443 Kempsville Road Norfolk, VA 23502 Phone: (757) 455-6100
EIN: 541038721
Gara Child RTC Ages 6-13
Grissom Child RTC Ages 6-13
K-House Child RTC Ages 6-13
Lawless Adolescent RTC Ages 13-17
Power Adolescent RTC Ages 13-17
Wilcox Adolescent RTC Ages 13-17 M&F M&F M&F M
M
24/7
01/24/2013
07/10/2013
01/24/2013
Facility Type {RTCDally Per·Diem
Doysaf Operation
Patient Bed Capacity
Initio/ Certification Date
WASHINGTON
| WA |
| RTC |
| Tamarack Center |
2901West Fort George Wright Drive Spokane, WA 99224 Phone: (509) 326-8100
EIN: 911216841
| Adolescent |
| M&F |
| 24/7 |
| 16 |
| 12/22/1995 |
| 12/24/2010 |
Appendix A. GLOSSARY OF ACRONYMS AND TERMS
Acronyms
Table A-1-List of Acronyms
Monthly Mental Health Facilities Usting Report
GLOSSARY OF ACRONYMS AND TERMS
Terms
Table A-2-List of Program Terms substance use issues
Adolescent Neuro Adolescent Sub Use Full
Adolescent Unit West
FageA-2
Montbly Mental Health Facilities Usting Report
GLOSSARY OF ACRONYMS AND TERMS
Table A 2-List of Program Terms
Ch Child Neuro Child/Adolescent Child/Adolescent Full Child/Adolescent Half Child/Preadolescent
Yo
Monthly Mental Health Facilities Usting Report image2.png image3.png image4.png image5.png image6.png image7.png image8.png image9.png image1.png
File details come from the government source that posted it. Updated .