Provider Demographics
NPI:1043978224
Name:THE SEVILLENO GROUP, LLC
Entity Type:Organization
Organization Name:THE SEVILLENO GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERIE MAE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVILLENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-749-7286
Mailing Address - Street 1:405 KIMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6006
Mailing Address - Country:US
Mailing Address - Phone:321-926-3191
Mailing Address - Fax:
Practice Address - Street 1:405 KIMBERLY CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6006
Practice Address - Country:US
Practice Address - Phone:321-926-3191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility