Healthcare Provider Details

I. General information

NPI: 1952215899
Provider Name (Legal Business Name): PALM GARDEN RETIREMENT HOME & DEMENTIA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8891 E HERNDON AVE
CLOVIS CA
93619-9089
US

IV. Provider business mailing address

2814 RIALTO AVE
CLOVIS CA
93611-6545
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-1657
  • Fax: 559-436-4704
Mailing address:
  • Phone: 559-515-6189
  • Fax: 559-436-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: CAMALAH KOPACZ
Title or Position: PRESIDENT
Credential: RN
Phone: 559-917-0440