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DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 2. AGENCY INFORMATION (Be Very Brief and Concise) <br /> Please provide the following information about your agency (2 pages OR LESS): <br /> a) Years in Operation, Date of Incorporation (Month/Year): 02/74 <br /> b) Agency's Purpose/Mission (no more than a few sentences): <br /> Our mission is to promote, enhance and support recovery for men, women and <br /> children affected by substance use disorder and mental illness by using a holistic, <br /> evidence-based and person-centered approach. Our expertise and broad array of <br /> treatment services stabilize, nurture and enhance the personal growth and <br /> development of those we serve so that they can recover to live rich, full lives. <br /> c) Types of Services the Agency Provides (bullet format): <br /> • 24/7/365 Urgent Behavioral HealthCare (Facility-based Crisis and Detoxification) <br /> • Mobile Crisis Management <br /> • Short and long-term residential rehabilitation/halfway houses <br /> • Intensive outpatient services for children and adults <br /> • Aftercare <br /> • Psychiatric evaluation <br /> • Medication management, <br /> • Integrated primary health care clinic <br /> • Pro bono counseling for those in need <br /> • Compeer services for those with Severe and Persistent Mental Illness <br /> • Parenting education <br /> • Community resource referrals <br /> • Community intervention support for children and adults <br /> • We serve clients of all ages, regardless of their ability to pay. <br /> d) Agency's History with Providing These Services: <br /> Freedom House Recovery Center began over 40 years ago as a non-hospital <br /> medical detox and halfway house for recovering alcoholics in Chapel Hill. Since <br /> then Freedom House has consistently grown to address the critical and changing <br /> needs of the 75,000+ North Carolinians in our service area affected by substance <br /> use disorder and mental illness by expanding both our services and geographic <br /> reach through innovative programs and partnerships. We enjoy the reputation as a <br /> leader in our field and have become the largest provider of mental health and <br /> substance abuse treatment in our service area and Cardinal Innovations has <br /> selected us as a Comprehensive Community Clinic. <br /> We serve individuals, young children through the senior years, who suffer from <br /> mental illness and/or substance use disorders. Our comprehensive, best-practice <br /> based programs serve the low-income, uninsured, indigent and homeless <br /> populations. Last year, Freedom House served 12,000+ individuals, including over <br /> 3,000 children or adolescents and nearly 1,000 who were over the age of 55. Thirty <br /> percent of our clients are dually-diagnosed, suffering from both a mental illness and <br /> Agency Information 1/31/2017 11:11:58 AM Page 5 of 37 <br />