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General NPI Number Information
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NPI Number | 1598241507
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Entity Type | Organization
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Legal Business Name | HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 4705 LAKE FOREST DRIVE
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City | CINCINNATI
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State | OH
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Zip | 45242
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Country | US
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Telephone | 888-733-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 3419 VIA LIDO STE 144
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF PROGRAM OFFICER
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Name | BRYAN BIXLER
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Credential |
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Telephone | 888-733-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 01-7637
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 01-7637
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License Number State | OH
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