Healthcare Provider Details

I. General information

NPI: 1205771805
Provider Name (Legal Business Name): ANGEL'S SUNRISE VILLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 FLORADALE WAY
LINCOLN CA
95648-2458
US

IV. Provider business mailing address

2544 FLORADALE WAY
LINCOLN CA
95648-2458
US

V. Phone/Fax

Practice location:
  • Phone: 916-847-0842
  • Fax: 916-409-0700
Mailing address:
  • Phone: 916-847-0842
  • Fax: 916-409-0700

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: ALPESH AMIT KUMAR
Title or Position: PRESIDENT
Credential: ADMINISTRATOR
Phone: 916-847-0842