65E-9 Licensure Information Residential Treatment Centers and Therapeutic Group Homes (8/2/06)

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1 District 1 Agency Name Belle Point Mailing Address 1221 West Lakeview Avenue, Pensacola Fl Phone (850) Contact Craig Woolard or Lee Riley License Expiration Agency Name Coppenger House Mailing Address 1221 West Lakeview Avenue, Pensacola Fl Phone (850) Contact Craig Woolard or Lee Riley License Expiration 7/19/07 Agency Name Lakeview Meridian Mailing Address 1221 West Lakeview Avenue, Pensacola Fl Phone (850) Contact Jay Layfield Lee Riley License Expiration 9/16/06 1

2 District 2 Agency Name Apalachicola Forest Youth Camp Mailing Address P.O. Box 240 Hosford, Fl Phone (850) Contact Donnie Reed Type JITP Residential Treatment Center License s # 02bcca License Expiration 12/31/06 Agency Name Devereux Specialized Therapeutic Group Home Mailing Address 5850 TG Lee Blvd, Suite 400, Orlando Fl Phone (850) Contact Eddie Hadley License Expiration 6/26/07 Agency Name Devereux SIPP Mailing Address 5850 TG Lee Blvd, Suite 400, Orlando Fl Phone (850) Contact Mary Ann Davenport License Expiration 1/31/07 2

3 District 3 Agency Name The Achievement Center Mailing Address 173 SE Baya Drive, Lake City, Fl Phone (352) Contact Darrin Marshall License Expiration 11/28/005 3

4 District 4 Agency Name St. Augustine Youth Services Mailing Address 50 Saragossa Street, St. Augustine Fl Phone (904) Contact Schuyler Siefker License Expiration 2/20/07 Agency Name Daniel Memorial Mailing Address 3725 Belfort Road, Jacksonville, Fl Phone (904) Contact James D. Clark License Expiration Agency Name Ten Broeck - Jacksonville Mailing Address 6300 Beach Blvd., Jacksonville, Fl Phone (904) Contact Paul Andrews License Expiration 4

5 Suncoast Pinellas, Hillsborough, Pasco, Sarasota, Desoto (p. 1 of 2) Agency Name Carlton Manor ECP Mailing Address th Street North, Pinellas Park, Fl Phone (727) Contact Paul Buxbaum License s # License Expiration 2/13/2006 Agency Name Carlton Manor-Group Home 2 Mailing Address 5802 Fairfield Avenue North, St. Petersburg, Fl Phone (727) Contact Paul Buxbaum License Expiration 10/24/06 Agency Name Manatee Palms Youth Services Mailing Address st Street West, Bradenton, Fl Phone (941) Contact Linda Kautz Type SIPP Residential Treatment Center License Expiration Specialty Hospital 5

6 Suncoast (p 2 of 2) Agency Name Tampa Bay Academy Mailing Address Boyette Road, Riverview, Fl Phone (813) Contact Margaret Stept License Expiration 6/01/07 Agency Name PEMHS Mailing Address th Street North Pinellas Park, Fl Phone (772) Contact Gerald Wennlund License Expiration 12/26/06 Agency Name PEMHS (Paces) Mailing Address 1614 Palm Way, Largo, Fl Phone ( Contact Gerald Wennlund License Expiration 12/26/06 6

7 District 7 (p 1 of 2) Agency Name Devereux (Cocoa) Mailing Address 225 Burnett Road Cocoa, Fl Phone (321) Contact Michael Becker License Expiration 10/18/2006 Agency Name Devereux (Chuluota) Mailing Address 2180 Snowhill Road Chuluota, Fl Phone (407) Contact License s # License Expiration 06/26/2006 Agency Name Sunnyside (aka Park Place) Mailing Address 84 Beehive Circle Ave. St. Cloud, Fl Phone (407) Contact James Shanks License Expiration 02/25/2006 7

8 District 7 (2 of 2) Agency Name Devereux - Orlando Mailing Address 6147 Christian Way, Orlando, Fl Phone (407) Contact Michael Becker License Expiration Agency Name University Behavioral Center Mailing Address 2500 Discovery Drive, Orlando Fl Phone (407) Contact David l. Beardsley License Expiration 8

9 District 8 Agency Name Alternate Family Care Mailing Address 4055 Pinewood Road, Melbourne, Fl Phone (321) Contact David Ferguson License Expiration 12/10/2005 Agency Name David Lawrence Center Mailing Address 6075 Golden Gate Parkway, Naples Fl Phone (239) Contact David Schimmel License Expiration 01/03/2006 9

10 District 9 Agency Name The Children s Place at Home Safe Mailing Address th Avenue South Phone (561) Contact Linda Wyckoff License Expiration 11/30/06 10

11 District 10 p. 1 0f 2) Agency Name Chrysalis Center-Monarch House Mailing Address 3521 W. Broward Blvd, 3 rd Floor, Ft. Lauderdale, Fl Phone (954) Contact Lisa Bates License Expiration 02/26/2006 Agency Name Alternate Family Care Omega Group Home Mailing Address 1001 W. Oakland Park Blvd 3 rd Floor Sunrise, Fl Phone (954) Contact Sarah Cummings r License Expiration 9/08/06 Agency Name Alternate Family Care Alpha Group Home Mailing Address 1001 W. Oakland Park Blvd 3 rd Floor Sunrise, Fl Phone (954) Contact Sarah Cummings r License Expiration 9/08/06 11

12 District 10 (P. 2 of 2) Agency Name Alternate Family Care Alpha Group Home Mailing Address 5925 McKinley Street, Hollywood, Florida 33021, Fl Phone (954) Contact Jennifer Fulmer Type Residential Treatment Center License Expiration 10/04/06 Agency Name Citrus Mental Health Mailing Address 4175 W. 20 th Avenue #rd Floor Hialeah, Fl Phone (305) Contact Gisela Suarez License Expiration 7/27/07 12

13 District 11 Agency Name Citrus Mental Health Dade Mailing Address 4175 West 20 th Avenue, Hialeah, Fl Phone (305) Contact Maria A. Alonson License Expiration Agency Name Citrus Mental Health Dade Mailing Address 4175 West 20 th Avenue, Hialeah, Fl Phone (305) Contact Maria A. Alonson License Expiration Agency Name Center for Family and Child Enrichment Mailing Address Phone Contact Type License Expiration 13

14 District 12 Agency Name Florida United Methodist Mailing Address P.O. Box 6299 Enterprise, fl Phone (386) Contact Wayne Strickland License Expiration 3/13/07 14

15 District 13 (p. 1 of 2) Agency Name: Life Stream Behavioral Center-Estes House Address: Estes Road, Eustis, FL Mailing Address: PO Box , Leesburg, FL Phone: (352) Executive Director: Jonathan M. Cherry-Pres/CEO Type: Therapeutic Group Home License Number: # License Expiration: 11/19/05 Agency Name Trinity Point Ranch Mailing Address East 5 th Street, Umatilla, fl Phone (352) Contact Shelby Chavis License Expiration 7/20/06 Agency Name: Life Stream Behavioral Center-SIPP Address: 2020 Tally Road, Leesburg, FL Mailing Address: PO Box , Leesburg, FL Phone: (352) Executive Director: Jonathan M. Cherry Type: SIPP Residential Treatment Center License Number: # License Expiration: 04/05/06 15

16 District 13 (p 2 of 2) Agency Name Ten Broeck - Ocala Mailing Address 3130 S.W. 25 th Avenune, Ocala, Fl Phone (352) Contact Robert Weinholdi Type SIPP Residential Treatment Center License Expiration 10/27/06 16

17 District 14 Agency Name Riverview Mailing Address Phone Contact License Expiration Agency Name Park Place Mailing Address Phone Contact License Expiration 17

18 District 15 Agency Name Deveruex Mailing Address 225 North Burnett Road, Cocoa Fl Phone (321) Contact Scott LeGrand License Expiration 10/18/06 Agency Name Sandy Pines Mailing Address SE Tequesta Terrace, Tequesta, Fl Phone (561) Contact Michael Anthony License Expiration 8/7/06 Source: SAMH Program Office 18

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