FAIR HAVEN COMMUNITY HEALTH CLINIC INC NPI 1043679863

NPI Information

  • NPI: 1043679863
  • Provider Name: FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • Doing Business As: FAIR HAVEN COMMUNITY HEALTH CENTER
  • Address: 426 EAST ST
    NEW HAVEN, CT
    ZIP 06511
  • Phone: (203) 777-7411

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NPI Details

FAIR HAVEN COMMUNITY HEALTH CLINIC, INC is a federally qualified health center (fqhc) clinic center in New Haven, CT. FAIR HAVEN COMMUNITY HEALTH CLINIC, INC NPI is 1043679863. The provider is registered as an organization entity type.
The provider Is Doing Business As Fair Haven Community Health Center.

The provider's business location address is:

426 EAST ST
NEW HAVEN, CT
ZIP 06511-018
Phone: (203) 777-7411
Fax: (203) 777-8506

The provider's authorized official is Suzanne P Lagarde .
The authorized official title is Ceo and has the following contact phone number (203) 777-7411.

The enumeration date for this NPI number is 2/22/2016 and was last updated on 2/22/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

What is NPI?

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This page was last updated on: 3/30/2025

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