NPIMap

Organization Active NPI

JWCH Institute, Inc

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1811548712
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JWCH INSTITUTE, INC
Practice address
1670 E 120 Street
West Support BLDG #14 FL 2
Los Angeles, CA 90059-3026
Phone
(323) 201-4516
NPI assigned
Sep 23, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Authorized official

Name
Al Ballersteros
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

1670 E 120 Street
West Support BLDG #14 FL 2
Los Angeles, CA 90059-3026

Mailing address

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

Other names 1

  • Wesley Health Centers-MLK Recuperative Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200608002552 CA Part A Provider - Federally Qualified Health Center (FQHC) 1850394123 Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN A01080

Legal name
JWCH INSTITUTE INC
Doing business as
WESLEY HEALTH CENTERS - MLK RECUPERATIVE CARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 28, 2020
Last certification
May 28, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 4, 1960 in CA
Enrollment address
1670 E 120TH St
West Support BLDG #14 FL 2
Los Angeles, CA 90059-3026

National Provider Directory

National Provider Directory
Tax ID family
Wesley Health Centers - Michael Antonovich Dental Clinic68 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 15

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 Operational/Managerial ControlChief Dental Officer Nov 14, 2016
Jeanne Lam Individual Corporate OfficerChief Financial Officer Jul 1, 2005
Eduardo Saucedo Individual Corporate DirectorBoard Member Jul 26, 2016
Jerri Santo Individual Operational/Managerial ControlDirector of MLK Recuperative Care Sep 6, 2019
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
Maria a Padron Individual Corporate DirectorBoard Member Dec 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": "1569196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569196800000",
    "number": "1811548712",
    "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": "1670 E 120 STREET",
            "address_2": "WEST SUPPORT BLDG #14 FL 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593026",
            "telephone_number": "323-201-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JWCH INSTITUTE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-23",
        "last_updated": "2019-09-23",
        "status": "A",
        "authorized_official_last_name": "BALLERSTEROS",
        "authorized_official_first_name": "AL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "323-201-4516"
    },
    "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": "Wesley Health Centers-MLK Recuperative Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.