Healthcare Provider Details

I. General information

NPI: 1023506714
Provider Name (Legal Business Name): HOTEL CALIFORNIA BY THE SEA BELLEVUE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 114TH AVE SE STE 180
BELLEVUE WA
98004-6955
US

IV. Provider business mailing address

3419 VIA LIDO STE 145
NEWPORT BEACH CA
92663-3908
US

V. Phone/Fax

Practice location:
  • Phone: 844-766-8717
  • Fax:
Mailing address:
  • Phone: 844-766-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberBHA.FS.60874242
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberBHA.FS.60874242
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberBHA.FS.60874242
License Number StateWA

VIII. Authorized Official

Name: BRYAN BIXLER
Title or Position: CHIEF PROGRAM OFFICER
Credential:
Phone: 844-766-8717