07D2175225 CLIA NUMBER - FAIR HAVEN COMMUNITY HEALTH CLINIC, INC

Laboratory Demographics

CLIA Number: 07D2175225

Facility Name: FAIR HAVEN COMMUNITY HEALTH CLINIC, INC

Facility Address:
221 WEST MAIN ST
BRANFORD, CT
ZIP 06405
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Facility Phone Number: 203 777-7411

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1568832640

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	07D2175225
LAB Type	Federally Qualified Health Center
Facility Name	FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Street	221 WEST MAIN ST
City	BRANFORD
State	CT
ZIP	06405
Phone	203 777-7411
CertificateType	4
CertificateEffectiveDate	11/18/2023
CertificateExpirationDate	11/17/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024