| Fair Haven Community Health Clinic, Inc | |
|
14 Sycamore Way Branford CT 06405-6551 | |
| (203) 777-7411 | |
| (203) 777-8506 |
| Full Name | Fair Haven Community Health Clinic, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 14 Sycamore Way, Branford, Connecticut |
| Authorized Official Name and Position | Yolymar Herrera (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2037777411 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fair Haven Community Health Clinic, Inc 374 Grand Ave New Haven CT 06513-3733 Ph: (203) 752-5248 | Fair Haven Community Health Clinic, Inc 14 Sycamore Way Branford CT 06405-6551 Ph: (203) 777-7411 |
| NPI Number | 1447767934 |
|---|---|
| Provider Enumeration Date | 01/05/2018 |
| Last Update Date | 01/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447767934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0901 (Connecticut) | Primary |
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