Provider Demographics
NPI:1356029458
Name:KALO WELLNESS, LLC
Entity type:Organization
Organization Name:KALO WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-375-7457
Mailing Address - Street 1:350 E 400 S STE 237
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3178
Mailing Address - Country:US
Mailing Address - Phone:801-375-7574
Mailing Address - Fax:801-363-7574
Practice Address - Street 1:4133 W PIONEER PKWY STE 110
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2059
Practice Address - Country:US
Practice Address - Phone:801-375-7457
Practice Address - Fax:801-363-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care