NPIMap

Organization Active NPI

The Childrens Clinic 'Serving Children and Their Families'

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
National Provider Identifier
1215493259
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'
Practice address
540 E Artesia Blvd
Long Beach, CA 90805-1476
Phone
(562) 277-9456
Fax
(562) 216-6197
NPI assigned
Feb 14, 2019
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
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

540 E Artesia Blvd
Long Beach, CA 90805-1476

Mailing address

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

Other practice location 1

1900 Atlantic Ave Ste 200
Long Beach, CA 90806-5545
Phone (562) 277-9405

Other names 1

  • TCC FAMILY HEALTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200123000955 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870544919 Practice locations: Long Beach, CA

Federally qualified health center certification: CCN 921824

Legal name
THE CHILDREN'S CLINIC SERVING CHILDREN AND THEIR FAMILIES
Doing business as
TCC FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 20, 2020
Last certification
Jan 20, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1939 in CA
Enrollment address
540 E Artesia Blvd
Long Beach, CA 90805-1476

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
05D2170672TCC Family Health540 E Artesia Boulevard, Long Beach, CA 90805Certificate of waiverAug 14, 2027

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

Locations

1900 Atlantic Ave
Ste 200
Long Beach, CA 90806
Phone (562) 277-9405

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Catalina Cruz Individual Corporate OfficerBoard Member Aug 1, 2008
Phansy Peang Individual Corporate OfficerBoard Member Oct 1, 2004
Harold Milton Vandyke Individual Corporate OfficerBoard Member, President Oct 1, 2010
Corporate DirectorBoard Member, President Oct 1, 2010 100%
Andrew Horvath Individual Corporate DirectorChief Information Officer Sep 20, 2006
Mynor Aguirre Individual Corporate OfficerBoard Member Oct 1, 2010
Maria Chandler Individual Corporate DirectorChief Medical Officer Jul 1, 1992
Operational/Managerial ControlChief Medical Officer Jul 1, 1992
Ffombe Ndiforchu Individual Corporate OfficerBoard Member Oct 1, 2010
Elisa Nicholas Individual Corporate OfficerChief Executive Officer Jul 1, 1988 100%
Corporate DirectorChief Executive Officer Jul 1, 1988
W-2 Managing EmployeeChief Executive Officer Jul 1, 1988
Operational/Managerial ControlChief Executive Officer Jul 1, 1988 100%

NPI Registry JSON

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1215493259",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E ARTESIA BLVD",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908051476",
            "telephone_number": "562-277-9456",
            "fax_number": "562-216-6197"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Atlantic Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908065545",
            "country_code": "US",
            "telephone_number": "562-277-9405",
            "fax_number": "562-216-6197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-14",
        "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": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TCC FAMILY HEALTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TCC FAMILY HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.