Healthcare Provider Details

I. General information

NPI: 1467060764
Provider Name (Legal Business Name): HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7745 IVYGATE LN
MONTGOMERY OH
45242-5119
US

IV. Provider business mailing address

4705 LAKE FOREST DRIVE
CINCINNATI OH
45242
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 TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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