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General NPI Number Information
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NPI Number | 1831919356
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Entity Type | Organization
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Legal Business Name | JWCH INSTITUTE, INC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 640 S MAIN ST
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City | LOS ANGELES
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State | CA
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Zip | 90014-2004
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Country | US
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Telephone | 213-947-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 5650 JILLSON ST
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City | COMMERCE
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State | CA
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Zip | 90040-1482
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Country | US
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Telephone | 323-201-4516
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ALVARO PROSPERO BALLESTEROS
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Credential |
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Telephone | 323-201-4516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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