Organization
FAIR HAVEN COMMUNITY HEALTH CLINIC INC.
Active
Other names
Fair haven Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUZANNE P LAGARDE M.D. (CEO)
(203) 752-5129
Entity
Organization
Contact information
Practice address
339 EASTERN ST, NEW HAVEN, CT 06513-2463
(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
261QD0000X
Dental Clinic/Center
0722
CT
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
0009
CT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
0533
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235736
—
CT
Enumeration date
01/23/2008
Last updated
02/11/2016
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