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General NPI Number Information
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NPI Number | 1861745606
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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 | 10/17/2012
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 3580 E IMPERIAL HWY
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City | LYNWOOD
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State | CA
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Zip | 90262-2602
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Country | US
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Telephone | 310-763-3078
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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 | 323-215-0171
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Authorized Official
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Title or Position | CEO
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Name | ALVARO 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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 550002189
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License Number State | CA
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