APPENDIX A-3 TRICARE-AUTHORIZED RESIDENTIAL TREATMENT CENTERS

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1 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-3 Following are the rate adjustments for those RTCs whose 1995 per diems were below the 30th percentile of all established fiscal year 1995 rates. The rates were adjusted by the lesser of the Consumer Price Index - Urban Wage Earners (CPI-U) for medical care for the annual reporting period of July 1, 1994, to July 1, 1995 (4.4 percent) or the amount that brought the rate up to the 30th percentile level ($429). These rates are for payment of services provided on or after October 1, NOTE: This listing is for residential treatment center per diem rates only. It does not reflect a facility s status as a TRICARE-authorized residential treatment center. Information regarding a facility s current status as an authorized provider can be obtained from the appropriate contractor. ALABAMA Charter Academy of Mobile 5800 Southland Center Mobile, AL Facility No EIN: Hillcrest Hospital RTC 6869 Fifth Avenue South Birmingham, AL Facility No EIN: ALASKA Charter North Ascent RTC 2530 Debarr Road Anchorage, AK EIN: A3-1

2 APPENDIX A-3 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 ARIZONA Wendy Paine O Brien RTC 5055 North 34th St. Phoenix, AZ Facility No EIN: (B) Desert Hills Ctr for Youth & Family 2797 N. Introspect Drive Tucson, AZ Facility No EIN: Westbridge RTC-Children & Adolescent 1830 E. Roosevelt Street Phoenix, AZ Facility No EIN: ARKANSAS CPC Pinnacle Pointe Hospital RTC Financial Center Parkway Little Rock, AR EIN: CALIFORNIA Broad Horizons P.O. Box H Street Ramona, CA Facility No EIN: CPC San Luis Rey 335 Saxony Road Encinitas, CA Facility No EIN: A3-2

3 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-3 San Diego Center for Children 3002 Armstrong Street P.O. Box San Diego, CA Facility No EIN: Vista San Diego Center 3003 Armstrong Street San Diego, CA Facility No EIN: COLORADO Brockhurst Extended Care Program P.O. Box E. Pikes Peak Colorado Springs, CO Facility No EIN: Cheyenne Mesa 1301 South 8th Street Colorado Springs, CO Facility No EIN: Mountain View Place, Cedar Springs 2135 Southgate Road Colorado Springs, CO Facility No EIN: West Pines at Lutheran Medical CTR P.O. Box Lutheran Parkway Wheatridge, CO EIN: A3-3

4 APPENDIX A-3 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 FLORIDA CBHS Bay Harbor Seminole Boulevard Largo, FL Facility No EIN: CPC Palm Bay CRC 4400 Dixie Hwy NE Palm Bay, FL EIN: Daniel Memorial 3725 Belfort Road Jacksonville, FL Facility No EIN: La Amistad RTC 201 Alpine Drive Maitland, FL Facility No EIN: Laurel Oaks RTC 6601 Central Florida Parkway Orlando, FL Facility No EIN: CBHS at Manatee Palms st Street Bradenton, FL Facility No. EIN: Rivendell of Fort Walton Beach 1015 Mar Walt Drive FT. Walton Beach, FL Facility No EIN: A3-4

5 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-3 Tampa Bay Academy Boyette Road Riverview, FL Facility No EIN: CPC St. Johns River Hospital CRC 6300 Beach Blvd. Jacksonville, FL EIN: University Behavioral Center 2500 Discovery Drive Orlando, FL EIN: GEORGIA CBHS of Atlanta at Laurel Heights 934 Briarcliff Road, N.E. Atlanta, GA Facility No EIN: HAWAII Kahi Mohala Fort Weaver Road Ewa Beach, HI Facility No EIN: IDAHO CPC Intermountain Hospital of Boise 303 N. Allumbaugh Street Boise, ID Facility No EIN: A3-5

6 APPENDIX A-3 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 INDIANA CBHS of Indiana at Jefferson 2700 River City Park Jeffersonville, IN EIN: KANSAS CPC College Meadows Hospital RTC College Boulevard Lenexa, KS Facility No. EIN: The Menninger Clinic RTC 5800 S.W. Sixth Topeka, KS EIN: LOUISIANA DePaul Hospital-RTC 1040 Calhoun Street New Orleans, LA Facility No EIN: MISSISSIPPI CPC Sand Hill Hospital RTC Program Highway 49 North Gulfport, MS EIN: MISSOURI Heartland Behavioral Health Svcs 1500 W. Ashland Nevada, MO Facility No EIN: A3-6

7 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-3 Piney Ridge Center, Inc Hospital Road Waynesville, MO Facility No EIN: NEVADA BHC Willow Springs Center 690 Edison Way Reno, NV Facility No EIN: NEW MEXICO Desert Hills Ctr for Youth & Family 5310 Sequoia, N.W. Albuquerque, NM Facility No. EIN: NORTH CAROLINA Cumberland Hospital 3425 Melrose Road P.O. Box Fayetteville, NC Facility No EIN: OKLAHOMA Shadow Mountain Hospital 6262 South Sheridan Road Tulsa, OK Facility No EIN: SOUTH CAROLINA Charter of Charleston 2777 Speissegger Drive Charleston, SC EIN: A3-7

8 APPENDIX A-3 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 TENNESSEE Charter Lakeside RTC 2911 Brunswick Road Memphis, TN Facility No EIN: Pine Point Center, Inc. 49 Old Hickory Blvd. Jackson, TN EIN: TEXAS BHC Cedar Crest 3500 South IH 35 Belton, TX Facility No EIN: CPC Capital Hospital Hunters Chase Drive Austin, TX EIN: CRC of San Antonio Coporate Woods Drive San Antonio, TX EIN: Crossing Point RTC/CPC Millwood 1011 North Cooper Arlington, TX Facility No EIN: A3-8

9 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-3 Healthcare Rehabilitation Center of Austin Box West Dittmar Austin, TX Facility No EIN: Healthcare Rehabilitation Center of Austin 1106 West Dittmar Austin, TX Facility No EIN: * Laurel Ridge Hospital Corporate Woods Drive P.O. Box San Antonio, TX Facility No EIN: (D) Meridell Achievement Center Highway 29 West P.O. Box 87 Liberty Hill, TX Facility No EIN Oak Grove Treatment Center 6436 Mark Drive Burleson, TX Facility No EIN: San Marcos Treatment Center Bert Brown Road P.O. Box 768 San Marcos, TX Facility No EIN: (B) A3-9

10 APPENDIX A-3 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 Southwest Mental Health Center 8538 Tom Slick Drive San Antonio, TX Facility No EIN: Devereux Foundation - Texas Ctr Box David Wade Drive Victoria, TX Facility No EIN: (D) The Oaks Treatment Center 1407 West Stassney Lane Austin, TX Facility No EIN: (C) Quest Hospital Adolescent RTC 7200 West 9th Avenue Amarillo, TX Facility No.: EIN: Woods Psychiatric Institute of Central Texas 4800 E. Rancier Blvd. P.O. Box 4010 Killeen, TX Facility No EIN: (B) Woods Behavioral Healthcare System Box 5749 Abilene, TX Facility No EIN: A3-10

11 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-3 UTAH CPC Olympus View Community Res Cntr 1430 East 4500 Salt Lake City, UT Facility No. EIN: Rivendell of Utah 5899 West Rivendell Drive West Jordon, UT Facility No EIN: VERMONT Brattleboro Retreat-Tyler RTC 75 Linden Street Brattleboro, VT EIN: VIRGINIA Charter Westbrook RTC 1500 Westbrook Avenue PO Box 9127 Richmond, VA EIN: HCA Poplar Springs 350 Poplar Drive Petersburg, VA Facility No. EIN: Psychiatric Institute of Richmond West Creek Pkwy Richmond, VA Facility No EIN: A3-11

12 APPENDIX A-3 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 Pines Treatment Center 1801 Portsmouth Blvd. Portsmouth, VA Facility No EIN: (B) WASHINGTON Continuum at Fairfax N.E. 132nd Street Kirkland, WA EIN: A3-12

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