NPIMap

Organization Active NPI

Fair Haven Community Health Clinic Inc.

Doing business as Fair haven Community Health Center

  • Federally Qualified Health Center (FQHC)
  • New Haven, CT
National Provider Identifier
1871770768
Registry record updated Feb 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0009 Issued in CT
Legal business name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC.
Doing business as
Fair haven Community Health Center
Practice address
339 Eastern St
New Haven, CT 06513-2463
Phone
(203) 777-7411
Fax
(203) 777-8506
NPI assigned
Jan 23, 2008
Last updated
Feb 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2016

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

Authorized official

Name
Ms. Suzanne P Lagarde, M.D.NPI 1114068848
Title
Ceo
Phone
(203) 752-5129

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 0722 CT
Federally Qualified Health Center (FQHC) 261QF0400X 0009 CT Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0533 CT

Addresses

Primary practice location

339 Eastern St
New Haven, CT 06513-2463

Mailing address

374 Grand Ave
New Haven, CT 06513-3733
Phone (203) 777-7411

Other identifiers 1

IdentifierTypeStateIssuer
004235736MedicaidCT

Other names 1

  • Fair haven Community Health Center Doing business as

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
Suzanna L Lin10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

339 Eastern St
New Haven, CT 06513
Phone (203) 469-5331

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455148800000",
    "number": "1871770768",
    "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": "203-777-7411",
            "fax_number": "203-777-8506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 EASTERN ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065132463",
            "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": "2008-01-23",
        "last_updated": "2016-02-11",
        "status": "A",
        "authorized_official_last_name": "LAGARDE",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-752-5129",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CT",
            "license": "0722",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "0009",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "0533",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235736",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fair haven Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; 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.