Healthcare Provider Details

I. General information

NPI: 1376794560
Provider Name (Legal Business Name): JWCH INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 S. SAN PEDRO STREET
LOS ANGELES CA
90013-2148
US

IV. Provider business mailing address

1910 W SUNSET BLVD SUITE 650
LOS ANGELES CA
90026-3281
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-1186
  • Fax:
Mailing address:
  • Phone: 213-484-1186
  • Fax: 213-413-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ALVARO P. BALLESTEROS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 213-484-1186