Organization
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Active
Organization
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Active
Parent organization
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Other names
Fair Haven Community Health Care at 150 Sargent Drive
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Authorized official
YOLYMAR HERRERA (CREDENTIALING MANAGER)
(203) 777-7411
Entity
Organization
Contact information
Practice address
150 SARGENT DR STE 1-300, NEW HAVEN, CT 06511-6100
(203) 777-7411
(203) 497-1887
Mailing address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
(203) 786-3004
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235736
—
CT
Enumeration date
10/26/2020
Last updated
10/26/2020
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