Provider Demographics
NPI:1710164702
Name:THE CHILDREN'S CLINIC, SERVING CHILDREN AND THEIR FAMILIES
Entity Type:Organization
Organization Name:THE CHILDREN'S CLINIC, SERVING CHILDREN AND THEIR FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:562-264-3985
Mailing Address - Street 1:701 E 28TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2784
Mailing Address - Country:US
Mailing Address - Phone:562-264-3985
Mailing Address - Fax:562-216-6197
Practice Address - Street 1:455 E COLUMBIA ST STE 201
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1620
Practice Address - Country:US
Practice Address - Phone:562-933-0400
Practice Address - Fax:562-933-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP11466FMedicaid