Organization
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Active
Other names
Fair Haven Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE LAGARDE MD (CEO)
(203) 777-7411
Entity
Organization
Contact information
Practice address
50 GRAND AVE, NEW HAVEN, CT 06513-3949
(203) 777-7411
(203) 777-8506
Mailing address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
(203) 777-8506
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Enumeration date
07/24/2015
Last updated
07/24/2015
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