Organization
JWCH INSTITUTE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALVARO P. BALLESTEROS (CHIEF EXECUTIVE OFFICER)
(213) 484-1186
Entity
Organization
Contact information
Practice address
3634 MARTIN LUTHER KING JR BLVD, LYNWOOD, CA 90262-2607
(310) 638-9025
Mailing address
1910 W SUNSET BLVD, STE 650, LOS ANGELES, CA 90026-3281
(213) 484-1186
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
CA
261QC1500X
Community Health Clinic/Center
—
CA
261QF0400X
Federally Qualified Health Center (FQHC)
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EAP70521F
—
CA
Enumeration date
11/27/2007
Last updated
11/27/2007
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