NPIMap

Organization Active NPI

Fair Haven Community Health Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Branford, CT
National Provider Identifier
1447767934
Registry record updated Jan 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0901 Issued in CT
Legal business name
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Practice address
14 Sycamore Way
Branford, CT 06405-6551
Phone
(203) 777-7411
Fax
(203) 777-8506
NPI assigned
Jan 5, 2018
Organization subpart
Yes
Parent organization
FAIR HAVEN COMMUNITY HEALTH CLINIC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2018

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

Authorized official

Name
Yolymar Herrera
Title
Credentialing Coordinator
Phone
(203) 777-7411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0901 CT Primary

Addresses

Primary practice location

14 Sycamore Way
Branford, CT 06405-6551

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040302000135 CT Part B Supplier - Clinic/Group Practice 4183511538 Receives reassigned benefits from 72 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Branford, CT; East Haven, CT; New Haven, CT; Branford, CT

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Fair Haven Community10 organizations share this tax ID, including this one
Part of
Fair Haven Community

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

374 Grand Ave
New Haven, CT 06513
Phone (203) 752-5203

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515110400000",
    "number": "1447767934",
    "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": "203-786-3004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 SYCAMORE WAY",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064056551",
            "telephone_number": "203-777-7411",
            "fax_number": "203-777-8506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR HAVEN COMMUNITY HEALTH CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAIR HAVEN COMMUNITY HEALTH CLINIC, INC",
        "enumeration_date": "2018-01-05",
        "last_updated": "2018-01-05",
        "status": "A",
        "authorized_official_last_name": "HERRERA",
        "authorized_official_first_name": "YOLYMAR",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "203-777-7411"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "0901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Branford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.