FAIR HAVEN COMMUNITY HEALTH CLINIC INC. NPI 1871770768

NPI Information

NPI: 1871770768
Provider Name: FAIR HAVEN COMMUNITY HEALTH CLINIC INC.

Doing Business As: FAIR HAVEN COMMUNITY HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
339 EASTERN ST
NEW HAVEN, CT
ZIP 06513
Phone: (203) 777-7411
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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 1871770768. 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:

339 EASTERN ST
NEW HAVEN, CT
ZIP 06513-463
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) 752-5129.

The enumeration date for this NPI number is 1/23/2008 and was last updated on 2/11/2016.

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
1	261QD0000X	Clinic/Center	Dental	0722	CONNECTICUT	No
2	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	0533	CONNECTICUT	No
3	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	0009	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	004235736	MEDICAID	CONNECTICUT
2	C00591	MEDICARE OSCAR/CERTIFICATION	CONNECTICUT
3	071817	MEDICARE OSCAR/CERTIFICATION	CONNECTICUT
4	07-1805	MEDICARE PIN	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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