NPIMap

Organization Active NPI

JWCH Institute, Inc.

Doing business as JWCH PATH Clinic

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1609486869
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JWCH INSTITUTE, INC.
Doing business as
JWCH PATH Clinic
Practice address
340 N Madison Ave
Los Angeles, CA 90004-3504
Phone
(323) 201-4516
NPI assigned
Aug 3, 2020
Last updated
Aug 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

340 N Madison Ave
Los Angeles, CA 90004-3504

Mailing address

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

Other names 1

  • JWCH PATH Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200929003251 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 1609486869. Details of each certification follow.

Federally qualified health center certification: CCN 921933

Legal name
JWCH INSTITUTE INC
Doing business as
JWCH PATH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 17, 2020
Last certification
Aug 17, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 4, 1960 in CA
Enrollment address
320 N Madison Ave
Ste a
Los Angeles, CA 90004-3791

National Provider Directory

National Provider Directory
Tax ID family
Wesley Health Center-Bellflower69 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 16

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 Jul 13, 2004
Andy Irie Individual Corporate OfficerChief Administrative Officer Jan 1, 2010
Paul Gerald Gregerson Individual Corporate OfficerChief Medical Officer Jan 1, 2001
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 Officer Apr 30, 2014
Alvaro P Ballesteros Individual Corporate OfficerChief Executive Officer Oct 1, 2003
Herbert Torrence Individual Corporate DirectorBoard Member Feb 28, 2017
Kathleen House Individual Corporate DirectorBoard Member - Secretary Nov 22, 2011
Silvia Hernandez Individual Corporate DirectorBoard Member Sep 23, 2014
Lawrence Fernandez Individual Corporate DirectorBoard Member Jun 25, 2002
Brenda Velasquez Individual Operational/Managerial ControlAdministrator Oct 9, 2007
Maria a Padron Individual Corporate DirectorBoard Member Feb 14, 2007
Sheila Eaton Individual Corporate DirectorBoard Member Sep 24, 2013

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": "1596412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1609486869",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 N MADISON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043504",
            "telephone_number": "323-201-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JWCH INSTITUTE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-03",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "BALLESTEROS",
        "authorized_official_first_name": "ALVARO",
        "authorized_official_middle_name": "PROSPERO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "323-201-4516",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JWCH PATH Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.