Basic Information
| Provider Information | |||||||||
| NPI: | 1376794560 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JWCH INSTITUTE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 W SUNSET BLVD | ||||||||
| Address2: | SUITE 650 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900263281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134841186 | ||||||||
| FaxNumber: | 2134133443 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 S. SAN PEDRO STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900132148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134841186 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2008 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | BALLESTEROS | ||||||||
| AuthorizedOfficialFirstName: | ALVARO | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2134841186 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TR0400X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.