1306029574 NPI number — JWCH INSTITUTE, INC

Table of content: (NPI 1306029574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306029574 NPI number — JWCH INSTITUTE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JWCH INSTITUTE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306029574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5650 JILLSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90040-1482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-484-1186
Provider Business Mailing Address Fax Number:
213-413-3443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6912 AJAX AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELL GARDENS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-4057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-562-5813
Provider Business Practice Location Address Fax Number:
323-326-1146
Provider Enumeration Date:
12/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BALLESTEROS
Authorized Official First Name:
ALVARO
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
213-484-1186

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  550000019 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CMM71083F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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