Provider Demographics
NPI:1164968590
Name:KALI WEST, LLC
Entity Type:Organization
Organization Name:KALI WEST, LLC
Other - Org Name:VILLA KALI MA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-246-8862
Mailing Address - Street 1:2912 MANAGUA PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7105
Mailing Address - Country:US
Mailing Address - Phone:619-246-8862
Mailing Address - Fax:760-683-5152
Practice Address - Street 1:2912 MANAGUA PL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-7105
Practice Address - Country:US
Practice Address - Phone:619-246-8862
Practice Address - Fax:760-683-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370154AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility