We use ALMA to derive the mass, length, and time scales associated with the nuclear starburst in NGC 253. This region forms ~2 M_sun/yr of stars and resembles other starbursts in scaling relations, with star formation consuming the gas reservoir 10 times faster than in galaxy disks. We present observations of CO, the high effective density transitions HCN(1-0), HCO+(1-0), CS(2-1), and their isotopologues. We identify ten clouds that appear as peaks in line emission and enhancements in the HCN-to-CO ratio. These clouds are massive (~10^7 M_sun) structures with sizes (~30 pc) similar to GMCs in other systems. Compared to disk galaxy GMCs, they show high line widths (~20-40 km/s) given their size, with implied Mach numbers ~90. The clouds also show high surface (~6,000 M_sun/pc^2) and volume densities (n_H2~2,000 cm^-3). Given these, self-gravity can explain the line widths. This short free fall time (~0.7 Myr) helps explain the more efficient star formation in NGC 253. We also consider the starburst region as a whole. The geometry is confused by the high inclination, but simple models support a non-axisymmetric, bar-like geometry with a compact, clumpy region of high gas density embedded in an extended CO distribution. Even for the whole region, the surface density still exceeds that of a disk galaxy GMC. The orbital time (~10 Myr), disk free fall time (<~ 3 Myr), and disk crossing time (<~ 3 Myr) are each much shorter than in a normal spiral galaxy disk. Some but not all aspects of the structure correspond to predictions from assuming vertical dynamical equilibrium or a marginally stable rotating disk. Finally, the CO-to-H2 conversion factor implied by our cloud calculations is approximately Galactic, contrasting with results showing a low value for the whole starburst region. The contrast provides resolved support for the idea of mixed molecular ISM phases in starburst galaxies.