FAIR HAVEN COMMUNITY HEALTH CLINIC, INC (NPI# 1568832640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568832640 |
| Entity Type | Organization |
| Organization Name | FAIR HAVEN COMMUNITY HEALTH CLINIC, INC |
| Other Organization Name | FAIR HAVEN COMMUNITY HEALTH CENTER EAST |
| Practice Address |
370 Hemingway Ave East Haven CT 06512-3240 |
| Mailing Address |
374 Grand Ave New Haven CT 06513-3733 |
| Practice Telephone | 2037777411 |
| Practice Fax Number | 2037778506 |
| Mailing Telephone | 2037777411 |
| Mailing Fax Number | 2037778506 |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2016-02-22 |
| Authorized Official Name | MRS. SUZANNE PAULA LAGARDE (CEO) |
| Authorized Official Telephone | 2037777411 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Fair Haven Community Health Center East | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588263016 | Fair Haven Community Health Clinic, Inc | Clinic/Center | 150 Sargent Dr Ste 1-300, New Haven, CT 06511-6100 | 2020-10-26 |
| 1447767934 | Fair Haven Community Health Clinic, Inc | Clinic/Center | 14 Sycamore Way, Branford, CT 06405-6551 | 2018-01-05 |
| 1043679863 | Fair Haven Community Health Clinic, Inc | Clinic/Center | 426 East St, New Haven, CT 06511-5018 | 2016-02-22 |
| 1811372469 | Fair Haven Community Health Clinic, Inc | Dentist | 50 Grand Ave, New Haven, CT 06513-3949 | 2015-07-24 |
| Street Address |
370 HEMINGWAY AVE |
| City | EAST HAVEN |
| State | CT |
| Zip Code | 06512-3240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255363115 | Stop and Shop Supermarket Co LLC | Durable Medical Equipment & Medical Supplies | 370 Hemingway Ave, East Haven, CT 06512-2317 | 2006-07-07 |
| 1164916631 | Matthew Mazzucco | Pharmacist | 370 Hemingway Ave, East Haven, CT 06512-3240 | 2018-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760040489 | Caroline Grace Wajdowicz | Specialist/Technologist | 114 Eddon Drive, East Haven, CT 06512 | 2019-05-29 |
| 1194074070 | Albert Marshall D'onofrio | Dentist | 300 Hemingway Ave., East Haven, CT 06512 | 2012-09-06 |
| 1073654158 | Tom A Davies I | Pharmacist | 392 Hemingway Ave., East Haven, CT 06512 | 2007-02-09 |
| 1346326840 | Susanne E Davis | Counselor | 595 Thompson Avenue, East Haven Counseling & Community Services, East Haven, CT 06512 | 2006-10-27 |
| 1124111828 | Ronald R. Montano | Dentist | 310 Main Street, East Haven, CT 06512 | 2006-10-02 |
| 1518985183 | Town of East Haven East Haven Counseling and Community Services | Clinic/Center | 595 Thompson Ave, East Haven Counseling & Community Services, East Haven, CT 06512 | 2006-07-18 |
| 1386629020 | Michael J. Vandlik, Dmd&associates LLC | Dentist | 280 Main Street, East Haven, CT 06512 | 2005-12-14 |
| 1174507230 | Tarvinder Pal Singh Arora | Dentist | 300 Hemingway Ave, Ste #3, East Haven, CT 06512 | 2005-12-02 |
| 1457342651 | Whispering Pines Rehabilitation and Nursing Center LLC | Skilled Nursing Facility | 38 Talmadge Avenue, East Haven, CT 06512 | 2005-11-04 |
| 1407477417 | T & S Home Care Agency LLC | Home Health | 5 Chamberlain Pl, New Haven, CT 06512 | 2020-04-30 |
| Find all providers in zip 06512 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548861024 | Staywell Health Care Inc | Clinic/Center | 160 Robbins St Ste 2, Waterbury, CT 06708-2652 | 2020-11-03 |
| 1447719091 | Charter Oak Health Center, Inc. | Clinic/Center | 693 Bloomfield Ave Ste 101, Bloomfield, CT 06002-2489 | 2019-03-13 |
| 1811480403 | First Choice Health Centers, Inc. | Clinic/Center | 150 N Main St Ste 230, Manchester, CT 06042-2086 | 2018-06-08 |
| 1851883458 | First Choice Health Centers, Inc. | Clinic/Center | 227 Middle Turnpike East, Manchester, CT 06040-4261 | 2018-05-31 |
| 1003332446 | Community Health Center Inc | Clinic/Center | 41 New St, Danbury, CT 06810-6512 | 2017-08-17 |
| 1225559826 | First Choice Health Centers, Inc. | Clinic/Center | 809 Main Street, East Hartford, CT 06108 | 2017-07-05 |
| 1760877864 | First Choice Health Centers, Inc. | Clinic/Center | 94 Connecticut Boulevard, East Hartford, CT 06108 | 2015-04-06 |
| 1669874855 | First Choice Health Centers, Inc. | Clinic/Center | 20 Maple Street, Maple Street School, Vernon, CT 06066 | 2014-09-19 |
| 1669874087 | First Choice Health Centers, Inc. | Clinic/Center | 70 Loveland Hill Road, Rockville High School, Vernon, CT 06066 | 2014-09-17 |
| 1548677982 | Community Health Center Inc | Clinic/Center | 730 State Pier Rd, New London, CT 06320-5862 | 2014-07-17 |
| Find all providers with the same taxonomy | ||||
| City | EAST HAVEN |
| Zip Code | 06512 |
Please comment or provide details below to improve the information on FAIR HAVEN COMMUNITY HEALTH CLINIC, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.