Insurance Provider Form

Please fill out the form below to provide us information pertaining to your insurance provider:

Insurance Provider Form

Step 1

Complete our easy form

Step 2

Set up assessment

Step 3

Coordinate Transportation

CONTACT US

Find out how we can help

Our compassionate counselors are standing by to answer any questions you may have. After helping thousands of people over the last 50 years, we have the resources to help you and your family and all your individual needs.

We Accept Most Insurances

Transportation Provided    PE Medicaid Provider    Weekend Admissions

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Get Help Now

Looking for addiction help for yourself or a loved one? Our professionally trained admissions coordinators are always available to assist you with any questions you might have.

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Make a Referral

For professional client referrals, please call our helpline and ask to be directed to the outreach team. You can also submit a contact form below to schedule a call with us.

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Schedule a Tour

If you are an addiction professional interested in our services, we would love to arrange a tour of our treatment facility with you.