Healthcare Provider Details

I. General information

NPI: 1215206503
Provider Name (Legal Business Name): JWCH INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 JILLSON ST
COMMERCE CA
90040-1482
US

IV. Provider business mailing address

5650 JILLSON ST
COMMERCE CA
90040-1482
US

V. Phone/Fax

Practice location:
  • Phone: 323-201-4516
  • Fax: 323-215-0170
Mailing address:
  • Phone: 213-484-1186
  • Fax: 213-413-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. AL BALLESTEROS
Title or Position: CEO
Credential:
Phone: 213-484-1186