Provider Demographics
NPI:1265040554
Name:HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.
Entity Type:Organization
Organization Name:HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PROGRAM OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIXLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-733-7755
Mailing Address - Street 1:4705 LAKE FOREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7172 PFEIFFER ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:888-733-7755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOTEL CALIFORNIA BY THE SEA CINCINNATI, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility