Fair Haven Community Health Clinic Inc

LBN: Fair Haven Community Health Clinic Inc
Fair Haven Community Health Clinic Inc is an health care organization with primary practice located at 374 Grand Ave , New Haven CT 06513. The organization recently has 4 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dental Hygienist, Other Service Providers / Midwife, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC). Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty. Fair Haven Community Health Clinic Inc can be contacted via phone (203) 777-7411, or through Lagarde, Suzanne via phone (203) 777-7411.

Contact Information

Primary practice address
374 Grand Ave New Haven CT 06513
Phone: (203) 777-7411
Fax: (203) 777-8506
Website:
Map and Directions
Authorized official contact:
Name: Lagarde, Suzanne Doctor of Medicine (MD)
Phone: (203) 777-7411

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X
Dental Providers / Dental Hygienist 124Q00000X
Other Service Providers / Midwife 176B00000X
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X

Profile Details

NPI number 1104803444
LBN Legal business name Fair Haven Community Health Clinic Inc
DBA Doing business as
Authorized official Lagarde, Suzanne Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 28th, 2005
Last updated Oct 30th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104803444 NPPES
Connecticut MEDICAID 004235736

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