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NPI Code Detail

MEDICARE: HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.

MEDICARE: HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center01-7637OH
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center01-7637OH

General Provider Information

NPI Number : 1598241507
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.
Provider Business Mailing Address
First Line : 3419 VIA LIDO STE 144
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92663-3908
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4705 LAKE FOREST DRIVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45242
Country : US
Telephone Number : 888-733-7755
Fax Number :
Authorized Official
Title or Position : CHIEF PROGRAM OFFICER
Name : BRYAN BIXLER
Credential :
Telephone Number : 888-733-7755
Provider Enumeration Date : 07/12/2018
Last Update Date : 05/07/2025

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