NPIMap

Organization Active NPI

Fair Haven Community Health Clinic Inc.

  • Federally Qualified Health Center (FQHC)
  • Branford, CT
National Provider Identifier
1003450347
Registry record updated Oct 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC.
Practice address
221 W Main St
Branford, CT 06405-4022
Phone
(203) 777-7411
Fax
(203) 777-8506
NPI assigned
Oct 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Yolymar Herrera
Title
HR Generalist/Credentialing Coord
Phone
(203) 777-7411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

221 W Main St
Branford, CT 06405-4022

Mailing address

374 Grand Ave
New Haven, CT 06513-3733
Phone (203) 752-5248

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 071947

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 15, 2020
Last certification
May 15, 2020
Ownership / control type
For profit – corporation
Facility address
221 W Main Street
Branford, CT 06405

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572393600000",
    "number": "1003450347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 GRAND AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133733",
            "telephone_number": "203-752-5248",
            "fax_number": "203-282-2979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 W MAIN ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064054022",
            "telephone_number": "203-777-7411",
            "fax_number": "203-777-8506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR HAVEN COMMUNITY HEALTH CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-30",
        "last_updated": "2019-10-30",
        "status": "A",
        "authorized_official_last_name": "HERRERA",
        "authorized_official_first_name": "YOLYMAR",
        "authorized_official_title_or_position": "HR GENERALIST/CREDENTIALING COORD",
        "authorized_official_telephone_number": "203-777-7411"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Branford, CT

Sources for this page

Verify at the official NPI Registry.