Organization
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Active
Parent organization
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Authorized official
YOLYMAR HERRERA (CREDENTIALING COORDINATOR)
(203) 777-7411
Entity
Organization
Contact information
Practice address
14 SYCAMORE WAY, BRANFORD, CT 06405-6551
(203) 777-7411
(203) 777-8506
Mailing address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 752-5248
(203) 786-3004
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
0901
CT
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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