Healthcare Provider Details

I. General information

NPI: 1275267155
Provider Name (Legal Business Name): HOTEL CALIFORNIA BY THE SEA BELLEVUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 99TH PL NE # B
KIRKLAND WA
98033-4314
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:
  • 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: 844-766-8717