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
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1861048084
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	:	323-201-4516
Fax Number	:	323-215-0228

Provider Business Practice Location Address
First Line	:	844 WEST AVENUE I
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2488
Country	:	US
Telephone Number	:	661-941-9555
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ALVARO P BALLESTEROS
Credential	:
Telephone Number	:	323-201-4516

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	12/29/2023

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