Healthcare Provider Details

I. General information

NPI: 1386588812
Provider Name (Legal Business Name): PAVILION SUNRISE ASSISTED LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4991 44TH ST.
SACRAMENTO CA
95820-5127
US

IV. Provider business mailing address

4991 44TH ST.
SACRAMENTO CA
95820-5127
US

V. Phone/Fax

Practice location:
  • Phone: 916-822-4408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JACQUELYN MELOSANTOS
Title or Position: CHIEF EXECUTIVE OFFICER, SECRETARY,
Credential:
Phone: 415-424-8409