Healthcare Provider Details

I. General information

NPI: 1639096753
Provider Name (Legal Business Name): SGBRC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24596 DARDANIA AVE
MISSION VIEJO CA
92691-4623
US

IV. Provider business mailing address

24596 DARDANIA AVE
MISSION VIEJO CA
92691-4623
US

V. Phone/Fax

Practice location:
  • Phone: 949-637-0295
  • Fax:
Mailing address:
  • Phone: 949-637-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ALBERT DAHBOUR
Title or Position: LICENSEE
Credential:
Phone: 949-637-0295