Healthcare Provider Details

I. General information

NPI: 1477929628
Provider Name (Legal Business Name): SEVILLE CIRCLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 GRISMER AVE.
BURBANK CA
91504
US

IV. Provider business mailing address

1900 GRISMER AVE
BURBANK CA
91504
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-3141
  • Fax: 818-843-5732
Mailing address:
  • Phone: 818-843-3141
  • Fax: 818-843-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: RAUL PARRADO
Title or Position: LICENSEE/ADMINISTRATOR
Credential:
Phone: 714-496-1630