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777 East Park Drive, Harrisburg, PA 17111-2754 TRICARE HOTLINE: 1-877-841-6413, FAX 1-877-841-6414, http://www.tricare.kepro.com

February 8, 2017 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 February 8, 2017:

Facility Name

Change Facility Type

State Effective Date

Coastal Harbor Treatment Center UHS of Savannah, LLC 1150 Cornell Avenue Savannah, GA 31406 Phone: (912) 354‐3911 EIN: 200931196

Recertification Facility RTC GA 01/06/2017

Youth Villages Youth Villages, Inc. 4685 Dorsett Shoals Road Douglasville, GA 30135 Phone: (901) 251‐4930 EIN: 581716970

Bed Capacity Change RTC GA 11/07/2016

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

Recertification Facility RTC KY 11/29/2016

Brynn Marr Hospital Brynn Marr Hospital 192 Village Drive Jacksonville, NC 28546 Phone: (910) 577‐1400 EIN: 56‐1317433

Recertification Facility RTC NC 11/16/2016

Palmetto Pines (Summerville) Behavioral Health 225 Midland Parkway Summerville, SC 29485 Phone: 843‐851‐5015 EIN: 570840074

Recertification Facility RTC SC 01/23/2017


Facility Name

Change Facility Type

State Effective Date

New Hope Carolinas, Inc. 101 Sedgewood Drive Rock Hill, SC 29732 Phone: (843) 572‐3498 EIN: 571099555

Recertification Facility RTC SC 01/11/2017

Cedar Crest Hospital and RTC HMTH Cedar Crest, LLC 3500 South IOH‐35 Belton, TX 76513 Phone: (254) 939‐2100 EIN: 201915868

Recertification Facility RTC TX 01/20/2017

Provo Canyon School UHS of Provo Canyon, Inc. 4501 North University Avenue Provo, UT 84604 Phone: (801) 227‐2000 EIN: 233044423

Recertification Facility RTC UT 01/10/2017


Monthly Mental Health Facility Listing Report As of August 8, 2016


TABLE OF CONTENTS

LISTING OF MENTAL HEALTH FACILITIES CERTIFIED BY TRICARE

Alabama……………………………………………………………………………………………………………………… 1

Alaska…………………………………………………………………………………………………………………………. 3

Arizona ……………………………………………………………………………………………………………………….. 3

Arkansas …………………………………………………………………………….......................................... 6

California ……………………………………………………………………..……………………………………………… 5

Colorado ……………………………………………………………………..………........................................ 6

Connecticut …………………………………………………………………..….…………………………………………. 7

Florida …………………………………………………………………………………………………………………………. 7

Georgia ………………………………………………………………………..…............................................. 11

Hawaii …………………………………………………………………………….….......................................... 14

Idaho ……………………………………………………………………………………………………………………………. 15

Illinois …………………………………………………………………………………………………………………………… Indiana ……………………………………………………………………………..…………………………………………..

1515

Kentucky ………………………………………………………………………….………………………………………….. 16

Maryland …..…………………………………………………………………………………………………………………… 17

Missouri ………………………………………………………………………………………………………………………. 17

Montana ……………………………………………………………………………………………………………………… 18

Nevada ……………………………………………………………………………........................................... 18

New Mexico ………………………………………………………………………........................................ 19

North Carolina ………………………………………………………………………........................................ 21

Ohio ………………………………………………………………………………..…………………………………………… 23

Pennsylvania ………………………………………………………………………………………………………………… 23

South Carolina …………………………………………………………………….……………………………………….. 24

Tennessee ……………………………………………………………………………………………………………………. 26

Texas ……………………………………………………………………………………………………………………………. 27

Utah ……………………………………………………………………………………………………………………………… 30

Virginia …………………………………………………………………………………………………………………………. 31

Washington …………………………………………………………………………………………………………………. 36

Appendix A – Glossary of Acronyms and Terms A1

MENTAL HEALTH FACILITY CERTIFICATION LISTING

State

Facility

Type Facility InformationDescription of Population

Served or ProgramGender

Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

AL SUDRF Bradford Health Services -

Huntsville

555 Sparkman Drive, Suite 208

Huntsville, AL 35816

Phone: (256) 895-3848

EIN: 631198286

Adult Morning

Adult Evening

Adult Mid Day

Adolescent

Male & Female

Male & Female

Male & Female

Male & Female

Monday-

Thursday

Monday -

Thursday

Monday -

Thursday

Monday-

Thursday

12

12

12

10

10/07/2002

10/07/2002

10/07/2002

10/07/2002

07/23/2013

07/23/2013

07/23/2013

07/23/2013


Huntsville Lodge

1600 Browns Ferry Road

Madison, AL 35758

Phone: (256) 461-7272

EIN: 631198286

Adult Inpatient Detox

Adult Partial

Adolescent

Inpatient/Detox

Adolescent Partial

Male & Female

Male & Female

Male & Female

Male & Female

24/7

Monday -

Sunday

24/7

Monday -

Sunday

23

5

11

3

11/29/1993

11/29/1993

11/29/1993

11/29/1993

04/03/2013

04/03/2013

04/03/2013

04/03/2013

ALABAMA

Page 1


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date


Pensacola

8333 North Davis Highway

Pensacola, FL 32514

850-308-7720

EIN: 631198286

Adult Evening - Half

Day Partial

Age 19+

Male & Female Monday -

Thursday

(5:30 pm - 9:30

pm)

15 3/4/2014 3/4/2014


Warrior Lodge

1189 Allbritton Road

Warrior, AL 35180

Phone: (205) 647-1945

EIN: 631198286

Adult Detox

Age 19+

Adult Inpatient

Rehabilitation

Age 19+

Adult PHP Full Day

Age 19+

Adult PHP Full Day

Age 19+

Male & Female

Male & Female

Male & Female

Male & Female

24/7

24/7

7 Days/Week

Monday-

Saturday

32

150

32

64

02/04/1993

02/04/1993

02/04/1993

03/04/2014

03/04/2014

03/04/2014

03/04/2014

03/04/2014

ALABAMA

Page 2


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

AK RTC DeBarr Residential Treatment

Center

Frontline Hospital, LLC

1500 DeBarr Circle

Anchorage, AK 99508

Phone: (907) 258-7575

EIN: 721539254

Yellow - Child

Ages 6 - 12

Red - Child

Ages 6-12

Orange - Adolescent

Ages 12 - 18

Pink - Adolescent

Ages 12 - 18

Blue - Adolescent

Ages 12 - 18

Green - Adolescent

Ages 12 - 18

Male/Female

Male/Female

Female

Female

Female

Female

24/7

24/7

24/7

24/7

24/7

24/7

10

10

10

10

10

10

7/16/2008

7/16/2008

7/16/2008

7/16/2008

7/16/2008

7/16/2008

5/12/2015

5/12/2015

5/12/2015

5/12/2015

5/12/2015

5/12/2015

AZ RTC Oasis Behavioral Health

Southwest Children’s Health

Services dba Formerly Parc Place

2190 North Grace Boulevard

Chandler, AZ 85225

Phone: 480-917-9301

EIN #: 860768611

Adolescent

Ages 12-17

Adolescent

Ages 12-17

M

F

24/7

24/7

2

2

01/17/2012

01/17/2012

04/13/2015

04/13/2015

ALASKA

ARIZONA

ARKANSAS

Page 3


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

AR RTC BHC Pinnacle Pointe Hospital

11501 Financial Center Parkway

Little Rock, AR 72211

Phone: (501) 223-3322

EIN: 621658502

CITC

Ages 5-12

AITC

Ages 12-17

AITC

Ages 12-17

Male & Female

Male

Female

24/7

24/7

24/7

22

16

16

07/22/1994

07/22/1994

07/22/1994

08/31/2015

08/31/2015

08/31/2015

Page 4


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

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

24/7

24/7

18

12

10/10/2014

10/10/2014

10/10/2014

10/10/2014

CA SUDRF Beacon House

667 Lighthouse Avenue

Suite 201

Pacific Grove, CA 93950

Phone: 831-372-2334

EIN: 94-1572781

Adult - Full Day

Adult - Half Day

Male & Female

Male & Female

9:00 a.m. to

4:00 p.m.

9:00 a.m. to

12:00 p.m.

10

10

08/09/2016

08/09/2016

08/09/2016

08/09/2016

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

Ages 18-65

Male & Female Monday-Friday 32 05/07/2010 07/11/2013

CA SUDRF Lompoc Valley Medical Center

dba Champion Center

303 South C Street

Lompoc, CA 93436

Phone: (805) 875-8800

EIN: 95-6001880

Adult

Ages 18+

Adult

Ages 18+

Male & Female

Male & Female

24/7

Monday-

Saturday

9am-8pm

34

30

11/16/2016

11/16/2016

11/16/2016

11/16/2016

ARKANSAS

CALIFORNIA

Page 5


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

CA RTC Center For Discovery - Lakewood

4136 Ann Arbor

Lakewood, CA 90712

Phone: 866-382-1306

EIN: 95-4628972

Adolescent RTC Eating

Disorder Speciality

Track

Ages 10-18

Male & Female 24/7 6 03/23/2016 03/23/2016

CA RTC Center For Discovery - Whittier

11911 Washington Boulevard

Whittier, CA 90606

Phone: 866-382-1306

EIN: 95-4628972

Adolescent RTC

Mental Health

Ages 10-18

Male & Female 24/7 25 05/23/2016 05/23/2016

CA PHP DEL AMO BHS

15434 West Sage Street

Victorville, CA 92392

760-381-1220

EIN: 23-2646424

Military - Half Day

8:00 a.m. to 11:50

a.m.

Ages 18 - 65

Civilian - Half Day

8:00 a.m. - 11:50 a.m.

Ages 18 - 65

Male & Female

Male & Female

Monday -

Friday

Monday-Friday

15

15

12/15/2015

12/15/2015

12/15/2015

12/15/2015

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

RTC

Ages 5-18

Male & Female 24/7 24 10/19/1990 08/18/2015

COLORADO

CALIFORNIA

Page 6


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

CT SUDRF Stonington Institute

Stonington Behavioral Health, Inc.

75 Swanton Hill Road

North Stonington, CT 06359

Phone: (860) 439-6005

EIN: 200687971

Adult Full Day

Adult Inpatient

Rehabilitation

Detox/Inpt. Rehab

Male & Female

Male & Female

Male & Female

Monday-Friday

24/7

24/7

24

25

13

01/28/2010

01/28/2010

01/28/2010

01/24/2013

01/24/2013

01/23/2013

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

Male & Female

Male &

Female

24/7

24/7

34

6

7/23/1999

7/23/1999

8/26/2015

8/26/2015

CONNECTICUT

FLORIDA

Page 7


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

FL RTC Palm Shores Behavioral Health

Center

(Formerly Manatee Palms Youth

Services)

(Premier Behavioral Solutions 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

Male & Female

Male

Female

Female

24/7

24/7

24/7

24/7

14

16

16

18

08/03/2015

5/29/2009

5/29/2009

10/1/2013

10/1/2013

10/1/2013

10/1/2013

10/1/2013

FL RTC University Behavioral, LLC d/b/a

University Behavioral Center

2500 Discovery Drive

Orlando, FL 32826

Phone: 407-281-7000

EIN: 205202458

Adolescent

Ages 12-18

Adolescent

Ages 13-18

Female

Male

24/7

24/7

16

16

4/3/2012

4/3/2012

4/4/2014

4/4/2014

Page 8


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

FL SUDRF Blue Springs Outpatient Center

owned by Emerald Coast

Behavioral Hospital LLC

2925 Optimist Drive

Marianna, FL 32448

Phone: (850) 372-4192

EIN: 27-0720873

Adult

Ages 18-75

SUDRF

Half Day

Adult

Ages 18-75

PHP

Half Day

Male & Female Monday to

Friday

12:30pm to

3:30pm

36 11/17/2016 11/17/2016

FL SUDRF Parkhill Outpatient Center



2633 Mahan Drive

Tallahassee, FL 32368

Phone: (850) 597-8542

EIN: 27-0720873

Adult

Ages 18-75

SUDRF

Half Day


Friday

12:30pm to

3:30pm

24 11/17/2016 11/17/2016

FL SUDRF Okaloosa Outpatient Center



2004 Lewis Turner Blvd. Suite B

Ft. Walton Beach, FL 32547

Phone: (850) 226-7893

EIN: 27-0720873

Adult

Ages 18-75

SUDRF

Half Day


Friday

12:30pm to

3:30pm

36 11/17/2016 11/17/2016

FLORIDA

Page 9


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

FL SUDRF The Friary

The Friary of Lakeview

4400 Hickory Shores Blvd

Gulf Breeze, FL 32563

Phone: (850) 932-9375

EIN: 590737872

Adult Detox

Adult Inpatient

Rehabilitation

Adult Sub Use Partial-

Full Day

Male & Female

Male & Female

Male & Female

24/7

24/7

Monday-

Sunday

8:30am to 5:00

pm

10

8

12

9/17/1993

9/17/1993

9/17/1993

10/31/2014

10/31/2014

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

Male & Female

Male & Female

Male & Female

24/7

Monday-

Sunday

Monday-

Sunday

16

70

16

07/19/1993

07/19/1993

07/19/1993

11/01/2012

11/01/2012

11/01/2012

FL PHP Blue Springs Outpatient Center



2925 Optimist Drive

Marianna, FL 32448

Phone: (850) 372-4192

EIN: 27-0720873

Adult

Ages 18-75

PHP

Half Day


Friday

9:00am to

12:00pm

36 11/17/2016 11/17/2016

FLORIDA

Page 10


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

FL PHP Parkhill Outpatient Center



2633 Mahan Drive

Tallahassee, FL 32368

Phone: (850) 597-8542

EIN: 27-0720873

Adult

Ages 18-75

PHP

Half Day


Friday

9:00am to

12:00pm

24 11/17/2016 11/17/2016

FL PHP Okaloosa Outpatient Center



2004 Lewis Turner Blvd. Suite B

Ft. Walton Beach, FL 32547

Phone: (850) 226-7893

EIN: 27-0720873

Adult

Ages 18-75

PHP

Half Day


Friday

9:00am to

12:00pm

36 11/17/2016 11/17/2016

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

Male & Female

Male & Female

Monday-

Thursday,

Saturday

Monday-

Thursday

8

12

10/05/2005

10/05/2005

06/26/2013

06/26/2013

Page 11


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

GEORGIA

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

Male & Female

Male & Female

Monday-

Thursday

Monday -

Thursday

18

8

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 9-17

Two North

Ages 7-17

Female

Male

24/7

24/7

18

18

09/17/2015

09/17/2015

01/06/2017

01/05/2017

GA RTC Devereux Georgia Treatment

Network

The Devereux Foundation

1291 Stanley Road

Kennesaw, GA 30152

Phone: 770-427-0147

EIN: 231390618

TRICARE Unit

13-20

Male & Female 24/7 30 11/16/2015 11/16/2015

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

Page 12


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

GEORGIA

GA RTC Ramsey Youth Services of

Georgia, Inc., d/b/a

Lake Bridge Behavioral Health

System

3500 Riverside Drive

Macon, GA 31210

Phone: (478) 477-3829

EIN: 352174803

Child

Ages 7-21

Child

Ages 7-21

Male

Female

24/7

24/7

24

16

11/15/2012

11/15/2012

6/8/2015

6/8/2015

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

Male & Female

Male & Female

Monday-Friday

Monday-Friday

18

12

11/05/2003

11/05/2003

2/23/2015

2/23/2015

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

Ages 18-80

Adult Substance Use

Partial - Half Day

Ages 18-80

Male & Female

Male & Female

Monday-Friday

Monday-Friday

6

6

02/02/2012

02/02/2012

11/28/2016

11/28/2016

Page 13


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

GEORGIA

GA RTC Youth Villages

Youth Villages, Inc.

4685 Dorsett Shoals Road

Douglasville, GA 30135

Phone: (901) 251-4930

EIN: 581716970

Lakeview Building-

Courtyard 5-2nd Floor

Ages 9-18

Male & Female 24/7 20 04/30/1997 4/26/2013

Addendum

executed on

11-7-16

HI RTC Kahi Mohala Behavioral Health

Sutter Health Pacific

91-2301 Fort Weaver Road

Ewa Beach, HI 96706

Phone: (808) 671-8511

EIN: 990298651

Adolescent

Ages 13-18

Child

Ages 4-12

Adolescent

Ages 13-18

Male & Female

Male & Female

Male & Female

24/7

24/7

24/7

16

8

8

9/16/1999

09/16/1999

05/11/2015

05/11/2015

05/11/2015

05/11/2015

HI RTC The Queen’s Medical Center/

Family Treatment Center

The Queen's Medical Center

1301 Punchbowl

Honolulu, HI 96813

Phone: (808) 538-9011

EIN: 990073524

Child / Adolescent

Ages 5 - 18

Male & Female 24/7 6 04/08/2003 10/22/2013

HAWAII

Page 14


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

ID RTC Eastern Idaho Regional Medical

Center - Behavioral Health Center

Eastern Idaho Health Services, Inc.

2280 East 25th Street

Idaho Falls, ID 83404

Phone: (208) 227-2100

EIN: 820436622

RTC

Ages 12 - 17

Male & Female 24/7 22 10/19/2009 11/06/2013

IL RTC Timberline Knolls

TK Behavioral, LLC

40 Timberline Drive

Lemont, IL 60439

Phone: (630) 257-9600

EIN#: 32-0383042

Inpatient

Rehabilitation /

Residental Program

Ages 18 - 65

Female 24/7 14 2/25/2014 11/6/2014

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

Male & Female 24/7 29 08/16/2004 08/26/2015

IDAHO

ILLINOIS

INDIANA

Page 15


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

IN RTC Midwest Center for Youth and

Families

South Shore Academy

2301 Cumberland

Valparaiso, IN 46383

219-766-2999

EIN: 23-2985289

Adolescent

Ages 12-20

Female 24/7 15 08/22/2013 08/22/2013

KY RTC 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 8-17

Female 24/7 18 8/23/2013 11/29/2016

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

Male & Female 24/7 14 06/02/2008 06/19/2013

KY RTC The Brook Hospitals - KMI

KMI Acquisition

8521 LaGrange Road

Louisville, KY 40242

Phone: (502) 426-6380

EIN: 205048153

Adolescent

Ages 13-17

Adolescent

Ages 13-17

Male

Female

24/7

24/7

18

24

06/8/2008

06/08/2008

06/19/2013

06/19/2013

KENTUCKY

INDIANA

Page 16


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

MD RTC Adventist Healthcare, Inc

Adventist Behavioral Health

14901 Broschart Road

Rockville, MD 20850

Phone: (301) 251-4500

EIN: 521532556

Adolescent

Ages 13 - 17 1/2

Male & Female 24/7 23 09/06/2011 10/22/2013

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

Male & Female 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

Ages 10-18

Male & Female 24/7 36 08/15/2005 01/12/2015

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 & Northeast

Ages 4-17

Male & Female 24/7 20 10/8/2007 9/19/2013

MARYLAND

MISSOURI

Page 17


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

MT RTC Shodair Children’s Hospital

Montana Children's Home &

Hospital

2755 Colonial Drive

Helena, MT 59601

Phone: (406) 444-7500

EIN: 810231789

Child

Ages 3-9

Pre-Adolescent

Ages 9-12

Adolescent

Ages 13-18

Male & Female

Male & Female

Male & Female

24/7

24/7

24/7

20

20

24

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

Male & Female 24/7 14 5/24/2012 2/5/2016

NV RTC Willow Springs Center

Willow Springs, LLC

690 Edison Way

Reno, NV 89502

Phone: (775) 858-3303

EIN: 621814471

Adolescent

Ages 13 - 18

Adolescent

Ages 13 - 18

Child

Ages 5 - 12

Male

Female

Male & Female

24/7

24/7

24/7

50

52

14

05/08/1990

05/08/1990

05/08/1990

04/26/2013

04/26/2013

04/26/2013

MONTANA

NEVADA

Page 18


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

NM RTC Mesilla Valley Hospital

BHC Mesilla Valley Hospital, LLC

3751 Del Rey Boulevard

Las Cruces, NM 88012

Phone: (800) 877-3500

EIN: 202612295

Adolescent

Ages 12-18

Adolescent

Ages 12-18

Male

Female

24/7

24/7

16

16

11/05/2004

11/05/2004

01/04/2015

01/04/2015

NM RTC PEAK BHS INC

Strategic Behavioral Health

Center

5045 McNutt Road

Santa Teresa, NM 88008

Phone: 575-589-3000

Carol Eck, CEO

EIN: 800895526

Adolescent

Ages 12-18

Adolescent

Ages 12-18

Adolescent

Ages 12-18

Adolescent

Ages 12-18

Male

Male

Male

Female

24/7

24/7

24/7

24/7

16

16

15

16

8/11/2015

8/11/2015

8/11/2015

8/1/2015

8/11/2015

8/11/2015

8/11/2015

8/1/2015

NEW MEXICO

Page 19


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

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

Ages 12-18

Adolescent

Ages 7 - 12

Adolescent

Ages 13-18

Adolescent

Ages 13 - 18

Adolescent

Ages 12-18

Male-Female

Female

Male

Male

Female

24/7

24/7

24/7

24/7

24/7

18

4

10

11

8

10/24/2012

10/24/2012

10/24/2012

10/24/2012

10/24/2012

11/22/2013

11/22/2013

11/22/2013

11/22/2013

11/22/2013

Page 20


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

NC RTC Brynn Marr Hospital

Brynn Marr Hospital

192 Village Drive

Jacksonville, NC 28546

Phone: (910) 577-1400

EIN: 56-1317433

Adolescent

Ages 10-17

Female 24/7 18 3/21/2007 11/16/2016

NC RTC SBH - Wilmington LLC

d/b/a Strategic Behavioral Center

- Wilmington

2050 Mercantile Drive

Leland, NC 28451

910-371-2500

EIN: 20-8405354

Hall 100

Adolescent

Ages 12-17

Hall 200

Adolescent

Ages 12-17

Hall 300

Adolescent

Ages 12-17

Hall 400

Adolescent

Ages 12-17

Male & Female

Male & Female

Male & Female

Male & Female

24/7

24/7

24/7

24/7

18

18

18

18

7/30/2013

7/30/2013

7/30/2013

7/30/2013

9/21/2015

9/21/2015

9/21/2015

9/21/2015

NORTH CAROLINA

Page 21


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

NC RTC SBH - Raleigh, LLC d/b/a

Strategic Behavioral Center -

Raleigh

3200 Waterfield Drive

Garner, NC 27529

919-800-4400

EIN: 27-3931436

Hallway 200

Adolescent

Ages 5-11

Hallway 300

Adolescent

Ages 12-17

Hallway 400

Adolescent

Ages 12-17

Hallway 500

Adolescent

Ages 12-17

Hallway 600

Adolescent

Ages 12-17

Male & Female

Male

Male

Female

Female

24/7

24/7

24/7

24/7

24/7

10

12

12

12

12

9/17/2015

9/17/2015

9/17/2015

9/17/2015

9/17/2015

9/17/2015

9/17/2015

9/17/2015

9/17/2015

9/17/2015

Page 22


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

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 Partial

Program / Full Day

Ages 18-199

Male & Female

Male & Female

24/7

Sunday -

Saturday

44

95

05/05/2003

05/05/2003

12/03/2013

12/03/2013

NC SUDRF Walter B. Jones Alcohol & Drug

Abuse Treatment Center

dba WBJ/ADATC

2522 W. 5th Street

Greenville, NC 27834

Phone: (252) 701-5091

EIN: 541436102

Adult Inpatient

Rehab/Detox

Ages 18+

Adult Inpatient

Rehab/Detox

Ages 18+

Male & Female

Male & Female

24/7

24/7

22

22

05/05/2003

05/05/2003

11/01/2016

11/01/2016

OH RTC Belmont Pines Hospital

Belmont Pines Hospital

615 Churchill-Hubbard Road

Youngstown, OH 44505

Phone: (330) 759-2700

EIN: 621658523

Child / Adolescent

Ages 5 - 18

Male & Female 24/7 56 11/02/2009 06/02/2016

PA RTC KidsPeace National Centers, Inc.

5300 KidsPeace Drive

Orefield, PA 18069-2044

Phone: 800-854-3123

EIN: 23-2654908

Adolescent

Ages 13 -20

Male & Female 24/7 24 4/5/2012 12/19/2013

NORTH CAROLINA

OHIO

PENNSYLVANIA

Page 23


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

SC RTC Palmetto Pines (Summerville)

Behavioral Health

225 Midland Parkway

Summerville, SC 29485

Phone: 843-851-5015

EIN: 570840074

Child / Adolescent

(South Hall)

Child / Adolescent

(North and CE Halls)

Female

Male

24/7

24/7

26

38

08/09/2012

08/09/2012

01/23/2017

01/23/2017

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

Male & Female

Male & Female

24/7

24/7

29

12

01/26/2006

08/12/2011

07/09/2013

08/06/2013

SC SUDRF Earle E. Morris Jr. Alcohol & Drug

Addiction Treatment

610 Faison Drive

Columbia, SC 29203

Phone: (803) 935-7103

EIN: 576000922

Cottage 1 - Adult

Inpatient Detox

Cottage 3 - Adult

Inpatient Detox

Cottage 6 - Adult

Inpatient Detox

Cottage 10 - Co-

Occurring

Cottage

11 - Detox/Stabilization

Male

Male

Female

Male & Female

Male &

Female

24/7

24/7

24/7

24/7

24/7

12

12

12

6

8

04/27/1993

04/27/1993

04/27/1993

04/27/1993

04/27/1993

08/30/2013

08/30/2013

08/30/2013

08/30/2013

08/30/2013

SC RTC New Hope Carolinas, Inc.

101 Sedgewood Drive

Rock Hill, SC 29732

Phone: (843) 572-3498

EIN: 571099555

Adolescent

Ages 12-20

Female 24/7 36 01/11/2017 1/11/2017

SOUTH CAROLINA

Page 24


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

SC PHP Three Rivers Residential

Treatment - Midlands Campus

200 Ermine Road

West Columbia, SC 29170

Phone: (803) 791-9918

EIN: 570884924

Pathways Partial

Program

Male & Female 1 pm 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

Mental Health /

Autism Dual Diagnosis

Unit

Ages 12 - 18

Child

Ages 5 - 12

Adolescent

Ages 12 - 18

Adolescent

Ages 12 - 18

Male & Female

Male & Female

Male

Female

24/7

24/7

24/7

24/7

18

14

18

18

03/26/2014

03/26/2014

03/26/2014

03/26/2014

03/26/2014

03/26/2014

03/26/2014

03/26/2014

SOUTH CAROLINA

Page 25


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

TN SUDRF Bradford Health Services -

Clarksville

235 A Dunbar Cave Road

Clarksville, TN 37043

Phone: (931) 542-9816

EIN: 631198286

Adult Full Day

Adolescent Evening

Half Day

Adult Evening Half

Day

Adult Half Day

Male & Female

Male & Female

Male & Female

Male & Female

8:30 am to

3:30 pm

4:00 pm to

7:00 pm

6:00 pm to

9:00 pm

9:00 am to

12:00 pm

10

10

20

20

4/30/2003

4/30/2003

4/30/2003

4/30/2003

6/26/2013

6/26/2013

6/26/2013

6/26/2013

TN RTC Compass Intervention Center

Keystone Memphis, LLC

7900 Lowrance Road

Memphis, TN 38125

Phone: (901) 758-2002

EIN: 621837606

100 Hall - Child

Ages 6 - 11

200 Hall - Adolescent

Ages 12 - 18

300 Hall - Adolescent

Ages 12-18

Male & Female

Female

Male

24/7

24/7

24/7

22

22

26

07/26/2003

06/10/2003

07/26/2013

04/03/2015

04/03/2015

04/03/2015

TN RTC Village Behavioral Health

d/b/a The Village

2431 Jones Bend Road

Louisville, TN 37777

Phone: (865) 970-1263

EIN: 270788813

Adolescent

13-17

Adolescent

13-17

Male

Female

24/7

24/7

12

12

06/04/2014

06/04/2014

06/04/2014

06/04/2014

TENNESSEE

TEXAS

Page 26


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

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

Male & Female 24/7 24 07/01/2008 01/20/2017

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

Ages 13-17

Child

Ages 4-12

Male & Female

Male & Female

24/7

24/7

22

20

01/01/1968

01/01/1968

05/11/2015

05/11/2015

TX RTC Meridell Achievement Center

12550 West Hwy 29

Liberty Hill, TX 78642

Phone: (800) 366-8656

EIN: 741655289

Hacienda/

Adolescent Girls

Ages 11-17

Bunkhouse/

Adolescent RTC

Ages 12-17

LaCasa/

Adolescent RTC

Ages 12-17

Liberty Hall/

Adolescent RTC

Ages 10-17

Ranch House

Ages 12-17

Female

Male & Female

Male & Female

Male & Female

Male & Female

24/7

24/7

24/7

24/7

24/7

22

16

16

64

16

10/10/1968

10/10/1968

10/10/1968

10/10/1968

10/10/1968

07/18/2013

Addendum

11/27/2016

07/18/2013

Addendum

11/27/2016

07/18/2013

Addendum

11/27/2016

07/18/2013

Addendum

11/27/2016

07/18/2013

Addendum

11/27/2016

Page 27


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

TX PHP Austin Counseling Connection

3355 Bee Cave Road, Suite 510

Austin, TX 78746

Phone: (512) 329-9455

EIN: 45-3233352

Partial Hospitalization

Program

Ages 18 - 75

Male & Female 9:00 am to

12:00 pm

Monday -

Friday

36 11/17/2016 11/17/2016

TX PHP Mission Resiliency at Laurel

Ridge

1900 East Elms Road, Suite 203

Killeen, TX 76542

Phone: (254) 781-4510

EIN: 432002326

Addiction Treatment

Services

Ages 18+


Friday

7:00 am to

10:00 am

and

11:30 am to

2:30 pm

and

3:00 pm to

6:00 pm

40 8/1/2014 10/27/2016

TX RTC San Marcos Treatment Center

120 Bert Brown Road

San Marcos, TX 78666

Phone: (615) 312-5700

EIN: 432002231

Springhill 1 East

Ages 6 - 14

Springhill 1 West

Ages 6 - 14

Springhill 2

Ages 11 - 17

New Heights

Ages 11 - 17

New Horizons 1

Ages 6 - 14

New Horizons 2

Ages 11 - 17

Female

Male

Female

Male

Male

Male

24/7

24/7

24/7

24/7

24/7

24/7

14

14

25

21

15

18

01/01/1968

01/01/1968

01/01/1986

01/01/1968

01/01/1968

01/01/1968

07/01/2016

07/01/2016

07/01/2016

07/01/2016

07/01/2016

07/01/2016

TEXAS

Page 28


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

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

Male & Female

Male & Female

Male & Female

Monday -

Friday

Monday -

Friday

Monday -

Friday

16

47

12

03/03/2011

03/03/2011

03/03/2011

07/28/2013

07/28/2013

07/28/2013

Page 29


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

TX SUDRF Red River Recovery Center

Red River Recovery, LLC

2501 Taylor Street

Wichita Falls, TX 76309

Phone: (940) 761-3034

EIN: 260269878

Substance Use Partial

Program - Full Day

Ages 18 - 80

Substance Use Partial

Program - Half Day

Ages 18 - 80

Male & Female

Male & Female

Monday -

Friday

8:30 am to

4:30 pm

Monday -

Friday

8:30 am to

12:00 pm

18

18

02/05/2007

02/05/2007

07/31/2013

07/31/2013

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+

Male & Female

Male & Female

Male & Female

24/7

24/7

Full Day

Monday -

Friday

24

47

28

06/17/2011

06/17/2011

06/17/2011

07/26/2013

07/26/2013

07/26/2013

UT RTC Center for Change

UHS of Timpanogos

1790 North State Street

Orem, UT 84057

Phone: (801) 224-8255

EIN: 203687800

Eating Disorders

Ages 12 - 21

Female 24/7 24 12/24/2010 5/16/2014

TEXAS

UTAH

Page 30


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

UT RTC Provo Canyon School

UHS of Provo Canyon, Inc.

4501 North University Avenue

Provo, UT 84604

Phone: (801) 227-2000

EIN: 233044423

TRICARE Unit

Ages 13-17

Male & Female 24/7 12 01/10/2017 01/10/2017

VA RTC Keystone Newport News, LLC

17579 Warwick Boulevard

Newport News, VA 23603

Phone: (757) 888-0400

EIN: 320066225

Adolescent -

Opportunity

Ages 11-18

Adolescent - Hope

Ages 11-18

Male

Female

24/7

24/7

12

12

06/09/2010

06/09/2010

08/14/2015

08/14/2015

VA RTC Harbor Point Behavioral Health

Center

301 Fort Lane

Portsmouth, VA 23704

Phone: 757-393-0061

EIN: 541465094

Adolescent - Oasis A

Ages 12-20

Adolescent - Compass

B

Ages 12-20

Child Unit

Ages 5 - 12

Adolescent - General

Psychiatric - Wings

Ages 12 - 20

Adolescent - Compass

C Ages 11 - 14

Female

Male

Male & Female

Male and

Female

Male

24/7

24/7

24/7

24/7

24/7

22

14

24

24

10

05/07/2012

05/07/2012

12/07/2012

12/07/2012

12/07/2012

10/28/2015

10/28/2015

10/28/2015

10/28/2015

10/28/2015

UTAH

VIRGINIA

Page 31


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

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

Male

Female

24/7

24/7

36

36

6/24/1993

6/24/1993

8/11/2015

8/11/2015

VA SUDRF Phoenix Houses of the Mid-

Atlantic, Inc.

200 North Glebe Road, Suite 104

Arlington VA, 22203

Phone: 703-841-0703

Toll Free Phone: 866-888-0821

EIN: 540805530

Adult Substance Use

Partial Hospitalization

Program

Ages 18+


Friday

9:30 am to

3:30 pm

18 9/23/2014 9/23/2014


Atlantic, Inc.

d/b/a The Boys Recovery Lodge

521 North Quincy Street

Arlington VA, 22203

Phone: 703-841-0703


EIN: 540805530

Boys Recovery Lodge

Ages 14-17

Male 24/7 12 10/24/2014 10/24/2014

VIRGINIA

Page 32


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date


Atlantic, Inc.

d/b/a The Girls Recovery Lodge

3100 Arlington Blvd

Arlington VA, 22203

Phone: 703-841-0703


EIN: 540805530

Girls Recovery Lodge

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

Male & Female 24/7 48 01/08/2010 5/10/2016

VA RTC The Kempsville Center for

Behavioral Health

860 Kempsville Road

Norfolk, VA 23502

Phone: (757) 461-4565

EIN: 541465094

Tides - Adolescent

Ages 11-18

Waves - Adolescent

Ages 11-18

Currents - Adolescent

Ages 11-18

Male

Female

Female

24/7

24/7

24/7

12

11

11

11/27/2000

01/15/2013

11/27/2000

9/9/2015

9/9/2015

9/9/2015

VIRGINIA

Page 33


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

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+

Male & Female

Male & Female

24/7

Monday-

Sunday

50

53

08/25/2010

08/25/2010

07/26/2013

07/26/2013

VA RTC North Spring Behavioral

Healthcare

42009 Victory Lane

Leesburg, VA 20176

Phone: 703-777-0800

EIN: 201215130

Trailblazers

(Bravo Unit)

Adolescent

Ages 9-17

Sunrise

(Charlie Unit)

Adolescent

Ages 9-17

Male

Female

24/7

24/7

11

16

3/8/2012

3/8/2013

7/22/2015

7/22/2015

VA RTC Cumberland Hospital for Children

and Adolescents

9407 Cumberland Road

New Kent, VA 23124

Phone: (804) 966-1636

EIN: 020567575

Adolescent

Ages 13-20

Male & Female 24/7 16 09/27/2011 12/02/2013

VIRGINIA

Page 34


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

VA SUDRF Williamsburg Place/The Farley

Center

Diamond Healthcare of

Williamsburg Inc.

5477 Moorestown Road

Williamsburg, VA 23188

Phone: (757) 565-0106

EIN: 541416559

Farley Center - PHP

(Extended / Longer

Term)

Ages 18+

Williamsburg Place -

PHP (Traditional Short

Term)

Ages 18+

Male & Female

Male & Female

Sunday -

Saturday

Full Day

Sunday -

Saturday

Full Day

30

30

01/13/2011

01/13/2011

10/27/2015

10/27/2015

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

Male & Female

Male & Female

Male & Female

Female

Male

Male

24/7

24/7

24/7

24/7

24/7

24/7

12

12

12

12

12

12

01/24/2013

07/10/2013

07/10/2013

07/10/2013

07/10/2013

07/10/2013

07/24/2015

07/24/2015

07/24/2015

07/24/2015

07/24/2015

07/24/2015

VIRGINIA

Page 35


State

Facility



Days of

Operation

Patient Bed

Capacity

Initial

Certification Date

Most Recent

Recertification

Date

WA RTC Tamarack Center

2901 West Fort George Wright

Drive

Spokane, WA 99224

Phone: (509) 326-8100

EIN: 911216841

Adolescent

Ages 12 - 17

Male & Female 24/7 16 12/22/1995 4/22/2015

WASHINGTON

Page 36

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