Basic Information
| Provider Information | |||||||||
| NPI: | 1801456439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JWCH INSTITUTE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5650 JILLSON ST | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232014516 | ||||||||
| FaxNumber: | 3232150228 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 S SAN PEDRO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900132148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133531118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2019 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | BALLESTEROS | ||||||||
| AuthorizedOfficialFirstName: | ALVARO | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3232014516 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.