Provider Demographics
NPI:1023506714
Name:HOTEL CALIFORNIA BY THE SEA BELLEVUE, LLC.
Entity type:Organization
Organization Name:HOTEL CALIFORNIA BY THE SEA BELLEVUE, 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:844-766-8717
Mailing Address - Street 1:3419 VIA LIDO STE 145
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3908
Mailing Address - Country:US
Mailing Address - Phone:844-766-8717
Mailing Address - Fax:
Practice Address - Street 1:1601 114TH AVE SE STE 180
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6955
Practice Address - Country:US
Practice Address - Phone:844-766-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABHA.FS.60874242261Q00000X, 261QM0850X, 261QR0405X, 261Q00000X
WABHA.FS.60874243324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility