NPIMap

Organization Active NPI

The Children's Clinic, Serving Children and Their Families

Doing business as TCC Family Health, Healthy Aging at St. Mary

  • Primary Care Clinic/Center
  • Long Beach, CA
National Provider Identifier
1023998986
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
THE CHILDREN'S CLINIC, SERVING CHILDREN AND THEIR FAMILIES
Practice address
1045 Atlantic Ave Ste 103
Long Beach, CA 90813-3414
Phone
(562) 264-3114
Fax
(562) 216-6179
NPI assigned
Sep 3, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

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

Authorized official

Name
Lou Levasa
Title
Operations & Licensing Specialist
Phone
(562) 264-3114

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1045 Atlantic Ave Ste 103
Long Beach, CA 90813-3414

Mailing address

701 E 28TH St Ste 200
Long Beach, CA 90806-2784
Phone (562) 264-3114

Other names 1

  • TCC Family Health, Healthy Aging at St. Mary Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260427002955 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870544919 Practice locations: Long Beach, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023998986. Details of each certification follow.

Federally qualified health center certification: CCN A11057

Legal name
THE CHILDREN'S CLINIC SERVING CHILDREN AND THEIR FAMILIES
Doing business as
TCC FAMILY HEALTH, HEALTHY AGING AT ST. MARY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 27, 2026
Last certification
Apr 27, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1045 Atlantic Ave
Long Beach, CA 90813-3408

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1045 Atlantic Ave
Ste 103
Long Beach, CA 90813
Phone (562) 264-3114

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Cesar Vazquez Individual Corporate DirectorDirector of Operations Apr 29, 2012
W-2 Managing EmployeeDirector of Operations Apr 29, 2012
Harold Milton Vandyke Individual Corporate OfficerBoard President Oct 1, 2010 100%
Andrew Horvath Individual Corporate DirectorChief Information Officer Sep 20, 2006
W-2 Managing EmployeeChief Information Officer Sep 20, 2006
Maria Chandler Individual Corporate DirectorChief Medical Officer Jul 1, 1992
W-2 Managing EmployeeChief Medical Officer Jul 1, 1992
Elisa Nicholas Individual Corporate DirectorChief Executive Officer Jul 1, 1988
W-2 Managing EmployeeChief Executive Officer Jul 1, 1988

NPI Registry JSON

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

{
    "created_epoch": "1756857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757376000000",
    "number": "1023998986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E 28TH ST STE 200",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062784",
            "telephone_number": "562-264-3114",
            "fax_number": "562-216-6197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 ATLANTIC AVE STE 103",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133414",
            "telephone_number": "562-264-3114",
            "fax_number": "562-216-6179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHILDREN'S CLINIC, SERVING CHILDREN AND THEIR FAMILIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-03",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A",
        "authorized_official_last_name": "LEVASA",
        "authorized_official_first_name": "LOU",
        "authorized_official_title_or_position": "OPERATIONS & LICENSING SPECIALIST",
        "authorized_official_telephone_number": "562-264-3114"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TCC Family Health, Healthy Aging at St. Mary",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TCC Family Health, Healthy Aging at St. Mary",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.