NPIMap

Organization Active NPI

The Childrens Clinic 'Serving Children and Their Families'

  • Community Health Clinic/Center
  • Long Beach, CA
National Provider Identifier
1205250263
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'
Practice address
2125 Santa Fe Ave
Long Beach, CA 90810-3547
Phone
(562) 264-4859
Fax
(562) 432-9590
NPI assigned
Feb 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Authorized official

Name
Jina Lawler, MSW
Title
Chief Operations Officer
Phone
(562) 264-3985

Specialties & licenses 2

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

Addresses

Primary practice location

2125 Santa Fe Ave
Long Beach, CA 90810-3547

Mailing address

701 E 28TH St
Suite 200
Long Beach, CA 90806-2759
Phone (562) 264-3985

Other names 1

  • The Children's Clinic Family Health Center Westside Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140416000316 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870544919 Practice locations: Long Beach, CA

Federally qualified health center certification: CCN 751066

Legal name
THE CHILDREN'S CLINIC SERVING CHILDREN AND THEIR FAMILIES
Organization structure
CorporationNon-profit
Incorporated
Nov 4, 1998 in CA
Enrollment address
2125 Santa Fe Ave
Long Beach, CA 90810-3547

Other NPIs with the same Medicare PAC ID 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0554782Children'S Clinic Family Health Center, the2125 Santa Fe Avenue, Long Beach, CA 90810Certificate of waiverMar 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
The Children'S Clinic Serving Children and Their Families17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Cynthia a. Begazo Individual Corporate OfficerChief Human Resources Officer Sep 28, 2015
Corporate DirectorChief Human Resources Officer Sep 28, 2015
Operational/Managerial ControlChief Human Resources Officer Sep 28, 2015
Harold Milton Vandyke Individual Corporate DirectorBoard Member - President Oct 1, 2010
Andrew Horvath Individual Corporate OfficerChief Information Officer Sep 20, 2006
Corporate DirectorChief Information Officer Sep 20, 2006
Operational/Managerial ControlChief Information Officer Sep 20, 2006
Maria Chandler Individual Corporate OfficerChief Medical Officer Jul 1, 1992
Corporate DirectorChief Medical Officer Jul 1, 1992
Operational/Managerial ControlChief Medical Officer Jul 1, 1992
Jina Lawler Individual Corporate OfficerChief Operations Officer Jun 1, 2008
Corporate DirectorChief Operations Director Jun 1, 2008
W-2 Managing EmployeeChief Operations Office Jun 1, 2008
Operational/Managerial ControlChief Operations Officer Jun 1, 2008
Elisa Nicholas Individual Corporate OfficerChieft Executive Officer Jul 1, 1988
Corporate DirectorChief Executive Officer Jul 1, 1988
Operational/Managerial ControlChief Operations Officer Jul 1, 1988 100%

NPI Registry JSON

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

{
    "created_epoch": "1392163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1205250263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E 28TH ST",
            "address_2": "SUITE 200",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062759",
            "telephone_number": "562-264-3985",
            "fax_number": "562-216-6197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 SANTA FE AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908103547",
            "telephone_number": "562-264-4859",
            "fax_number": "562-432-9590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-12",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "LAWLER",
        "authorized_official_first_name": "JINA",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "562-264-3985",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Children's Clinic Family Health Center Westside",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Children's Clinic Family Health Center Westside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.