Basic Information
| Provider Information | |||||||||
| NPI: | 1841661030 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JWCH INSTITUTE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JWCH INSTITUTE INC (BELL SHELTER) | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5650 JILLSON ST | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232014516 | ||||||||
| FaxNumber: | 3232150170 | ||||||||
| Practice Location | |||||||||
| Address1: | 5600 RICKENBACKER RD | ||||||||
| Address2: | |||||||||
| City: | BELL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902016418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232638840 | ||||||||
| FaxNumber: | 3232638348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | BALLESTEROS | ||||||||
| AuthorizedOfficialFirstName: | ALVARO | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3232014516 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.