MEDICARE: PAVILION SUNRISE ASSISTED LIVING INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1386588812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAVILION SUNRISE ASSISTED LIVING INC.

Provider Business Mailing Address
First Line	:	4991 44TH ST.
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4991 44TH ST.
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-5127
Country	:	US
Telephone Number	:	916-822-4408
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER, SECRETARY,
Name	:	JACQUELYN MELOSANTOS
Credential	:
Telephone Number	:	415-424-8409

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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