JWCH Institute Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

JWCH INSTITUTE INC

Doing business as

JWCH INSTITUTE, INC.-Project 50

Practice address

520 San Julian St
Los Angeles, CA 90013-1513

Phone

(213) 629-7431

Fax

(213) 629-7467

NPI assigned

Oct 7, 2015

Last updated

Apr 1, 2016By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• JWCH INSTITUTE, INC.-Project 50 Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881065548. Details of each certification follow.

• CCN 751880 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 751880

Legal name

JWCH INSTITUTE, INC.-PROJECT 50

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

Facility address

520 San Julian Street
Federal, CA 90013

Locations

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1881065548",
    "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": "520 SAN JULIAN ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900131513",
            "telephone_number": "213-629-7431",
            "fax_number": "213-629-7467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JWCH INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2016-04-01",
        "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 INSTITUTE, INC.-Project 50",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.