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NPI Code Detail

MEDICARE: JWCH INSTITUTE, INC.

MEDICARE: JWCH INSTITUTE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0800XRecovery Care Clinic/Center190718ANCA

General Provider Information

NPI Number : 1104293141
Entity Type Code : Organization
Provider Name (Legal Business Name) : JWCH INSTITUTE, INC.
Provider Business Mailing Address
First Line : 5650 JILLSON ST
Second Line :
City : COMMERCE
State : CA
Zip : 90040-1482
Country : US
Telephone Number : 323-813-0200
Fax Number : 323-813-0207
Provider Business Practice Location Address
First Line : 303 E 52ND ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-4513
Country : US
Telephone Number : 323-813-0200
Fax Number : 323-813-0207
Authorized Official
Title or Position : PROGRAM COORDINATOR
Name : VERA MARTINEZ
Credential :
Telephone Number : 323-813-0200
Provider Enumeration Date : 08/25/2015
Last Update Date : 06/08/2016

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