NPIMap

Organization Active NPI

JWCH Institute, Inc.

Doing business as JWCH (St George Hotel)

  • Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1538530225
Registry record updated Nov 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
JWCH INSTITUTE, INC.
Doing business as
JWCH (St George Hotel)
Practice address
115 E 3Rd St
Los Angeles, CA 90013-1301
Phone
(213) 613-1778
Fax
(213) 613-1884
NPI assigned
Oct 7, 2015
Last updated
Nov 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alvaro Ballesteros
Title
Chief Executive Officer
Phone
(323) 201-4516

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X CA Primary

Addresses

Primary practice location

115 E 3Rd St
Los Angeles, CA 90013-1301

Mailing address

5650 Jillson St
Commerce, CA 90040-1482
Phone (323) 201-4516

Other names 1

  • JWCH (ST GEORGE HOTEL) Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160629002011 CA Part A Provider - Federally Qualified Health Center (FQHC) 1850394123 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1538530225. Details of each certification follow.

Federally qualified health center certification: CCN 751882

Legal name
JWCH INSTITUTE INC
Doing business as
JWCH MEDICAL CLINIC @ ST. GEORGE HOTEL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 2016
Last certification
May 19, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 4, 1960 in CA
Enrollment address
115 E 3Rd St
Los Angeles, CA 90013-1301

National Provider Directory

National Provider Directory
Tax ID family
Wesley Health Centers - Midnight Mission71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thomas Grode Individual Corporate DirectorBoard Member Jan 26, 2016
Joseph Castel Individual Corporate DirectorBoard Member - Secretary Jul 13, 2004
Andy Irie Individual Corporate OfficerChief Administrative Officer Jan 1, 2010
Paul Gerald Gregerson Individual Corporate OfficerChief Medical Officer Jan 1, 2001
Christopher Ewing Individual Corporate DirectorBoard Member Jun 28, 2022
Ana Ortiz Individual Corporate OfficerChief Dental Officer Nov 14, 2016
Jeanne Lam Individual Corporate OfficerChief Financial Officer Jul 1, 2005
Eduardo Saucedo Individual Corporate DirectorBoard Member Jul 26, 2016
Tien Dang Individual Corporate OfficerChief Information Officer4 Apr 30, 2014
Alvaro P Ballesteros Individual Corporate OfficerChief Executive Officer Oct 1, 2003
Annette Sullivan Individual Corporate DirectorBoard Member Feb 23, 2021
Herbert Torrence Individual Corporate DirectorBoard Member Feb 28, 2017
Kathleen House Individual Corporate DirectorBoard Member - Vice Chair Nov 22, 2011
Silvia Hernandez Individual Corporate DirectorBoard Member Sep 23, 2014
Lawrence Fernandez Individual Corporate DirectorBoard Member Jun 25, 2002
Maria a Padron Individual Corporate DirectorBoard Member Feb 14, 2007
Jill Lubin Individual Operational/Managerial ControlClinic Administrator Sep 18, 1989
Sheila Eaton Individual Corporate DirectorBoard Member - Treasurer Sep 24, 2013
Marie S. Torres Individual Corporate DirectorBoard Member Apr 26, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
JWCH Medical Clinic @ Bell ShelterBell, CA, CCN 751883 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2015
Wesley Health Centers - Palmdale CentralPalmdale, CA, CCN 921169 Federally qualified health center Operational/Managerial Control (100%) Apr 15, 2019

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478044800000",
    "number": "1538530225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5650 JILLSON ST",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900401482",
            "telephone_number": "323-201-4516",
            "fax_number": "323-215-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E 3RD ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900131301",
            "telephone_number": "213-613-1778",
            "fax_number": "213-613-1884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JWCH INSTITUTE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2016-11-02",
        "status": "A",
        "authorized_official_last_name": "BALLESTEROS",
        "authorized_official_first_name": "ALVARO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "323-201-4516"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JWCH (ST GEORGE HOTEL)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.