Healthcare Provider Details

I. General information

NPI: 1598241507
Provider Name (Legal Business Name): HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 LAKE FOREST DRIVE
CINCINNATI OH
45242
US

IV. Provider business mailing address

3419 VIA LIDO STE 144
NEWPORT BEACH CA
92663-3908
US

V. Phone/Fax

Practice location:
  • Phone: 888-733-7755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number01-7637
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number01-7637
License Number StateOH

VIII. Authorized Official

Name: BRYAN BIXLER
Title or Position: CHIEF PROGRAM OFFICER
Credential:
Phone: 888-733-7755