| Grant Street Partnership at West Haven | |
|
285 Main St New Haven CT 06514-1930 | |
| (203) 503-3350 | |
| (203) 503-3370 |
| Full Name | Grant Street Partnership at West Haven |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 285 Main St, New Haven, Connecticut |
| Authorized Official Name and Position | Sol Maria Gonzalez (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2035033174 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grant Street Partnership at West Haven Po Box 7720 Credentialing Specialist New Haven CT 06519-0720 Ph: (203) 503-3174 | Grant Street Partnership at West Haven 285 Main St New Haven CT 06514-1930 Ph: (203) 503-3350 |
| NPI Number | 1578866364 |
|---|---|
| Provider Enumeration Date | 12/16/2010 |
| Last Update Date | 10/13/2022 |
| Certification Date | 10/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578866364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0518 (Connecticut) | Primary |
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