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Organization

JWCH INSTITUTE, INC.

Active
Other names
Wesley Health Centers (Vermont)
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ALVARO P. BALLESTEROS (CHIEF EXECUTIVE OFFICER)
(323) 201-4516
Entity
Organization

Contact information

Practice address
954 N VERMONT, LOS ANGELES, CA 90029-3529
(323) 201-4516
Mailing address
5650 JILLSON ST, COMMERCE, CA 90040-1482
(323) 201-4516
(323) 215-0170

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
251X00000X
Supports Brokerage Agency
261Q00000X
Clinic/Center
960001445
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
960001445
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
CMM71047F
CA
Enumeration date
12/19/2006
Last updated
02/01/2022
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