Provider Demographics
NPI:1417333998
Name:SEVILLE CIRCLE INC.
Entity Type:Organization
Organization Name:SEVILLE CIRCLE INC.
Other - Org Name:LEBLEU CHATEAU GOLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-496-1630
Mailing Address - Street 1:1911 GRISMER AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504
Mailing Address - Country:US
Mailing Address - Phone:818-295-2727
Mailing Address - Fax:818-843-2780
Practice Address - Street 1:1911 GRISMER AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504
Practice Address - Country:US
Practice Address - Phone:818-295-2727
Practice Address - Fax:818-843-2780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEVILLE CIRCLE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances