Organization
FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE LAGARDE MD (CEO)
(203) 777-7411
Entity
Organization
Contact information
Practice address
374 GRAND AVE, NEW HAVEN, CT 06513
(203) 777-7411
(203) 777-8506
Mailing address
374 GRAND AVE, NEW HAVEN, CT 06513
(203) 777-7411
(203) 777-8506
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
176B00000X
Midwife
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235736
—
CT
Enumeration date
12/28/2005
Last updated
10/30/2014
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