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General NPI Number Information
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NPI Number | 1952215899
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Entity Type | Organization
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Legal Business Name | PALM GARDEN RETIREMENT HOME & DEMENTIA CARE
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 8891 E HERNDON AVE
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City | CLOVIS
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State | CA
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Zip | 93619-9089
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Country | US
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Telephone | 559-203-1657
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Fax | 559-436-4704
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Provider Business Mailing Address
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Address Line | 2814 RIALTO AVE
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City | CLOVIS
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State | CA
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Zip | 93611-6545
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Country | US
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Telephone | 559-515-6189
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Fax | 559-436-4704
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAMALAH KOPACZ
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Credential | RN
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Telephone | 559-917-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | NULL
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