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

Laboratory Demographics

  • CLIA Code: 07D2175225
  • Facility Name: FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
  • Facility Address: 221 WEST MAIN ST
    BRANFORD, CT
    ZIP 06405
  • Facility Phone: 203 777-7411
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: MELLISA J. PENSA
  • NPI Number: 1568832640
  • Taxonomy: 261QF0400X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type Federally Qualified Health Center
Lab Director MELLISA J. PENSA

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This page was last updated on: 3/20/2025