APPENDIX A-6 TRICARE-AUTHORIZED RESIDENTIAL TREATMENT CENTERS
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1 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-6 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 Hill Crest BHS-AL 6869 Fifth Avenue South Birmingham, AL EIN: ARIZONA Wendy Paine O Brien Treatment Center 5055 North 34th St. Phoenix, AZ EIN: Westbridge Treatment Center 1830 E. Roosevelt Phoenix, AZ EIN: ARKANSAS BHC Pinnacle Pointe Hospital RTC, Inc Financial Center Parkway Little Rock, AR EIN: CALIFORNIA Broad Horizons P.O. Box H Street Ramona, CA EIN: BHC San Luis Rey Hospital, Inc. 335 Saxony Road Encinitas, CA EIN: A6-1
2 APPENDIX A-6 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 San Diego Center for Children 3002 Armstrong Street P.O. Box San Diego, CA EIN: Vista San Diego Center 3003 Armstrong Street San Diego, CA EIN: COLORADO Brockhurst Extended Care Program P.O. Box E. Pikes Peak Colorado Springs, CO EIN: Cedar Springs Hospital, Inc Southgate Road Colorado Springs, CO EIN: FLORIDA Valuemark Behavioral Healthcare System of Florida 6601 Central Florida Parkway Orlando, FL EIN: Charter BHS at Manatee Palms, LP st Street, West Bradenton, FL EIN: Tampa Bay Academy Boyette Road Riverview, FL EIN: BHC St. Johns River Hospital, Inc Beach Blvd. Jacksonville, FL EIN: Sandypines S.E. Tequesta Terrace Tequesta, FL EIN: A6-2
3 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-6 GEORGIA Charter BHS of Atlanta at Laurel Heights, LLC 934 Briarcliff Road, N.E. Atlanta, GA EIN: Charter Augusta BHS, LLC 3100 Perimeter Parkway Augusta, GA EIN: Inner Harbour Hospitals, LTD Dorsett Shoals Road Douglasville, GA EIN: HAWAII Sutter Health Pacific DBA Kahi Mohala Fort Weaver Road Ewa Beach, HI EIN: IDAHO BHC Intermountain Hospital, Inc. 303 N. Allumbaugh Street Boise, ID EIN: INDIANA Charter BHS of Indiana at Jefferson, LLC 2700 River City Park Road Jeffersonville, IN EIN: KANSAS BHC College Meadows Hospital, Inc College Boulevard Lenexa, KS EIN: The Menninger Clinic 5800 S.W. Sixth Avenue P.O. Box 829 Topeka, KS EIN: A6-3
4 APPENDIX A-6 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 St. Francis at Salina, Inc West Cloud Street Salina, KS EIN: LOUISIANA DePaul/Tulane Residential Treatment Center 1040 Calhoun Street New Orleans, LA EIN: MISSISSIPPI BHC Sand Hill Hospital, Inc Highway 49 North Gulfport, MS EIN: MISSOURI Crittenton Center Elm Avenue Kansas City, MO EIN: Piney Ridge Center, Inc Hospital Road P.O. Box 4067 Waynesville, MO EIN: NEVADA BHC Willow Springs Center 690 Edison Way Reno, NV EIN: NEW MEXICO Desert Hills Center- New Mexico 5310 Sequoia, N.W. Albuquerque, NM EIN: NORTH CAROLINA Cumberland Hospital 3425 Melrose Road P.O. Box (28309) Fayetteville, NC EIN: A6-4
5 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-6 OHIO BHC Belmont Pines Hospital, Inc. 615 Churchill - Hubbard Road Youngstown, OH EIN: OKLAHOMA Shadow Mountain Hospital, Inc South Sheridan Tulsa, OK EIN: TENNESSEE Charter Lakeside BHS, LLC 2911 Brunswick Road P.O. Box Memphis, TN EIN: TEXAS BHC Cedar Crest 3500 South IH 35 Belton, TX EIN: CRC of San Antonio Corporate Woods Drive San Antonio, TX EIN: Healthcare Rehabilitation Center of Austin Box West Dittmar Austin, TX EIN: Laurel Ridge Treatment Center Corporate Woods Drive P.O. Box San Antonio, TX EIN: Meridell Achievement Center W Hwy 29 P.O. Box 87 Liberty Hill, TX EIN A6-5
6 APPENDIX A-6 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 San Marcos Treatment Center Bert Brown Road P.O. Box 768 San Marcos, TX EIN: Southwest Mental Health Center 8538 Tom Slick Drive San Antonio, TX EIN: The Oaks Treatment Center 1407 West Stassney Lane Austin, TX EIN: Quest Hospital Adolescent RTC 7200 West 9th Avenue Amarillo, TX EIN: UTAH BHC Olympus View Hospital, Inc East 4500 South Salt Lake City, UT EIN: VERMONT Brattleboro Retreat-Tyler RTC 75 Linden Street Brattleboro, VT EIN: VIRGINIA Charter Westbrook BHS, LLC 1500 Westbrook Avenue PO Box 9127 Richmond, VA EIN: Poplar Springs Hospital 350 Poplar Drive P.O. Box 3060 Petersburg, VA EIN: Valuemark - West End BHS West Creek Pkwy Richmond, VA EIN: A6-6
7 TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 APPENDIX A-6 The Pines Treatment Center 825 Crawford Parkway Portsmouth, VA EIN: WASHINGTON Tamarack Center 2901 West Fort George Wright Spokane, WA EIN: Overlake Hospital Medical Center th Avenue NE Bellevue, WA EIN: A6-7
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APPENDIX A-4 TRICARE-AUTHORIZED RESIDENTIAL TREATMENT CENTERS
TRICARE/CHAMPUS POLICY MANUAL 6010.47-M DEC 1998 APPENDIX A-4 Following are the rate adjustments for those RTCs whose 1995 per diems were below the 30th percentile of all established fiscal year 1995 rates.
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More informationAPPENDIX A-3 TRICARE-AUTHORIZED RESIDENTIAL TREATMENT CENTERS
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