NPIMap

Organization Active NPI

The Childrens Clinic 'Serving Children and Their Families'

Doing business as TCC at the LB Multi-Service Center for the Homeless

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
National Provider Identifier
1942345939
Registry record updated May 2, 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'
Doing business as
TCC at the LB Multi-Service Center for the Homeless
Practice address
1301 W 12TH St
Long Beach, CA 90813-2720
Phone
(562) 264-4695
Fax
(562) 264-4273
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2023

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 960000104 CA
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1301 W 12TH St
Long Beach, CA 90813-2720

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
FHC11466FMedicaidCA

Other names 1

  • TCC at the LB Multi-Service Center for the Homeless Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071016000040 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870544919 Practice locations: Long Beach, CA

Federally qualified health center certification: CCN 051111

Legal name
THE CHILDREN'S CLINIC SERVING CHILDREN AND THEIR FAMILIES
Doing business as
THE CHILDRENS CLINIC AT THE LONG BEACH MULTI-SERVICE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2007
Last certification
Oct 17, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1939 in CA
Enrollment address
1301 W 12TH St
Long Beach, CA 90813-2720

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
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
Phansy Peang Individual Corporate Director Sep 12, 2007
Harold Milton Vandyke Individual Corporate DirectorBoard Member - President Oct 1, 2010 100%
Andrew Horvath Individual Corporate OfficerChief Information Officer Sep 20, 2006
W-2 Managing EmployeeChief Information Officer Sep 20, 2006
Operational/Managerial ControlChief Information Officer Sep 20, 2006
Maria Chandler Individual Corporate OfficerChief Medical Officer Jul 1, 1992
W-2 Managing EmployeeChief Medical Officer Jul 1, 1992
Operational/Managerial ControlChief Medical Officer Jul 1, 1992
Elisa Nicholas Individual Corporate OfficerChief Executive Officer Sep 12, 2007
W-2 Managing EmployeeChief Executive Officer Sep 12, 2007
Operational/Managerial ControlChief Executive Officer Sep 12, 2007 100%
Susan Wise Individual Corporate Director Sep 12, 2007

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682985600000",
    "number": "1942345939",
    "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": "1301 W 12TH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908132720",
            "telephone_number": "562-264-4695",
            "fax_number": "562-264-4273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A",
        "authorized_official_last_name": "LAWLER",
        "authorized_official_first_name": "JINA",
        "authorized_official_middle_name": "L.",
        "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": "CA",
            "license": "960000104",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11466F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TCC at the LB Multi-Service Center for the Homeless",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TCC at the LB Multi-Service Center for the Homeless",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.