FAIR HAVEN COMMUNITY HEALTH CLINIC, INC (NPI# 1811372469) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811372469 |
| Entity Type | Organization |
| Organization Name | FAIR HAVEN COMMUNITY HEALTH CLINIC, INC |
| Other Organization Name | FAIR HAVEN COMMUNITY HEALTH CENTER |
| Practice Address |
50 Grand Ave New Haven CT 06513-3949 |
| 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 | 2015-07-24 |
| Last Update Date | 2015-07-24 |
| Authorized Official Name | SUZANNE 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 | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers | ||
| N | 124Q00000X | Dental Hygienist | Dental Providers | ||
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 367A00000X | Advanced Practice Midwife | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Fair Haven Community Health Center | 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 |
| 1568832640 | Fair Haven Community Health Clinic, Inc | Family Medicine | 370 Hemingway Ave, East Haven, CT 06512-3240 | 2015-10-01 |
| Street Address |
50 GRAND AVE |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06513-3949 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609206135 | Spretha Kadavath | Dentist | 50 Grand Ave, New Haven, CT 06513 | 2013-11-19 |
| 1730713512 | Maranda Hyde | Registered Nurse | 50 Grand Ave, New Haven, CT 06513-3949 | 2020-03-02 |
| 1851868889 | Chikaodili Olusola Obidike | Dentist | 50 Grand Ave, New Haven, CT 06513-3949 | 2018-10-29 |
| 1558855049 | Leah Marie Mawhinney | Advanced Practice Midwife | 50 Grand Ave, New Haven, CT 06513-3949 | 2018-06-18 |
| 1295225407 | Annette Lilianna Nasiadka | Dental Hygienist | 50 Grand Ave, New Haven, CT 06513-3949 | 2018-05-14 |
| 1427583400 | Victoria Rose Massey | Dentist | 50 Grand Ave, New Haven, CT 06513-3949 | 2017-04-27 |
| 1922531920 | Chana Schaffer | Advanced Practice Midwife | 50 Grand Ave, New Haven, CT 06513-3949 | 2017-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366906141 | Edward Rivera | Case Manager/Care Coordinator | 458 Grand Ave., Suite 103, New Haven, CT 06513 | 2019-01-25 |
| 1134698442 | Village of Angels Home Health Care LLC | Respite Care | 470 James Street, Suite 007, New Haven, CT 06513 | 2018-11-15 |
| 1609358068 | Sarah Khalil | Pharmacist | 745 Foxon Road, East Haven, CT 06513 | 2018-09-02 |
| 1912358375 | Domanice Poindexter | Nurse Practitioner | Caremore Health, 444 Foxon Rd, East Haven, CT 06513 | 2016-06-28 |
| 1568839876 | My Fair Haven Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 72 Grand Ave, New Haven, CT 06513 | 2015-08-24 |
| 1871979567 | Sankofa Counseling LLC | Community/Behavioral Health | 64 Thompson St Ste A101, East Haven, CT 06513 | 2015-08-04 |
| 1578967287 | Curtis Stewart | Pharmacy Technician | 661 Thompson Street, East Haven, CT 06513 | 2014-10-09 |
| 1548686322 | Davis Group LLC | Social Worker | 30 Grand Ave, New Haven, CT 06513 | 2014-03-17 |
| 1124459615 | James Lucas IIi | Dietitian, Registered | 167 Old Foxon Road, Unit 30b, New Haven, CT 06513 | 2013-12-09 |
| 1992134878 | Joon Lee | Occupational Therapist | 918 Quinnipiac Ave #2, New Haven, CT 06513 | 2013-11-01 |
| Find all providers in zip 06513 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1043679863 | Fair Haven Community Health Clinic, Inc | Clinic/Center | 426 East St, New Haven, CT 06511-5018 | 2016-02-22 |
| 1750757282 | Downriver Community Services, Inc. | Clinic/Center | 58144 Gratiot Ave, New Haven, MI 48048 | 2015-08-19 |
| 1578866364 | Cornell Scott Hill Health Corporation | Clinic/Center | 62 Grant St, Grant Street Partnership, New Haven, CT 06519-2514 | 2010-12-16 |
| 1427351626 | Cornell Scott Hill Health Corporation | Clinic/Center | 911 State St, State Street Health Services, New Haven, CT 06511-3926 | 2010-12-09 |
| 1407159841 | Cornell Scott Hill Health Corporation | Clinic/Center | 226 Dixwell Ave, Dixwell Health Center, New Haven, CT 06511-3456 | 2010-12-07 |
| 1376871822 | Cornell Scott Hill Health Corporation | Clinic/Center | 400 Columbus Ave, New Haven, CT 06519-1233 | 2009-11-20 |
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| 1003332446 | Community Health Center Inc | Clinic/Center | 41 New St, Danbury, CT 06810-6512 | 2017-08-17 |
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| 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 | ||||
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| 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.