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General NPI Number Information
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NPI Number | 1952748246
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Entity Type | Organization
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Legal Business Name | JWCH
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 1218 E COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90221-3310
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Country | US
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Telephone | 310-608-1505
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Fax | 310-608-1406
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Provider Business Mailing Address
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Address Line | 1218 E COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90221-3310
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Country | US
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Telephone | 310-608-1505
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Fax | 310-608-1406
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Authorized Official
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Title or Position | SUBSTANCE ABUSE COUNSELOR
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Name | MS. JANINE E MATHIS
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Credential |
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Telephone | 310-608-1505
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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 | 952289916
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License Number State | CA
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