Provider Demographics
NPI:1346423787
Name:JWCH INSTITUTE, INC.
Entity Type:Organization
Organization Name:JWCH INSTITUTE, INC.
Other - Org Name:WESLEY HEALTH CENTER (LYNWOOD)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:P
Authorized Official - Last Name:BALLESTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-201-4516
Mailing Address - Street 1:5650 JILLSON ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1482
Mailing Address - Country:US
Mailing Address - Phone:323-201-4516
Mailing Address - Fax:323-215-0170
Practice Address - Street 1:3591 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2654
Practice Address - Country:US
Practice Address - Phone:310-223-1035
Practice Address - Fax:310-638-9080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JWCH INSTITUTE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-07
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000791261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP70521FMedicaid