Provider Demographics
NPI:1104293141
Name:JWCH INSTITUTE, INC.
Entity type:Organization
Organization Name:JWCH INSTITUTE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-813-0200
Mailing Address - Street 1:5650 JILLSON ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1482
Mailing Address - Country:US
Mailing Address - Phone:323-813-0200
Mailing Address - Fax:323-813-0207
Practice Address - Street 1:303 E 52ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-4513
Practice Address - Country:US
Practice Address - Phone:323-813-0200
Practice Address - Fax:323-813-0207
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JWCH INSTITUTE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-25
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190718AN261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care