Provider Demographics
NPI:1831836667
Name:KALI WEST, LLC
Entity type:Organization
Organization Name:KALI WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:760-343-5759
Mailing Address - Street 1:3790 VIA DE LA VALLE STE 313
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-4252
Mailing Address - Country:US
Mailing Address - Phone:760-814-8214
Mailing Address - Fax:
Practice Address - Street 1:3790 VIA DE LA VALLE STE 313
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-4252
Practice Address - Country:US
Practice Address - Phone:760-814-8214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder