1942345939 NPI number — THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'

Table of content: (NPI 1942345939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942345939 NPI number — THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TCC AT THE LB MULTI-SERVICE CENTER FOR THE HOMELESS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942345939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 E 28TH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90806-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-264-3985
Provider Business Mailing Address Fax Number:
562-216-6197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 W 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-264-4695
Provider Business Practice Location Address Fax Number:
562-264-4273
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  960000104 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FHC11466F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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