Healthcare Provider Details

I. General information

NPI: 1629947502
Provider Name (Legal Business Name): WESLEY HEALTH CENTERS- SKIDROW RESIDENTIAL CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 JILLSON ST
COMMERCE CA
90040-1482
US

IV. Provider business mailing address

515 CROCKER ST APT 6
LOS ANGELES CA
90013-2116
US

V. Phone/Fax

Practice location:
  • Phone: 323-201-4516
  • Fax:
Mailing address:
  • Phone: 323-201-4516
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ALVARO PROSPERO BALLESTEROS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 323-201-4516