FAIR HAVEN COMMUNITY HEALTH CLINIC INC
NPI 1104803444
Clinic/Center - Federally Qualified Health Center (FQHC) in New Haven, CT
About Fair Haven Community Health Clinic Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FAIR HAVEN COMMUNITY HEALTH CLINIC INC (NPI 1104803444) is a healthcare organization registered as a federally qualified health center (fqhc) in New Haven, Connecticut and active in the NPI registry since December 2005. The organization holds a CLIA Microscopy certificate valid through November 27, 2026 and lists Suzanne Lagarde, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Fair Haven Community Health Clinic Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
73Medicare enrollment records show 73 clinicians reassign Medicare billing to Fair Haven Community Health Clinic Inc, which bills Medicare for the services they deliver. Of these, 29 practice at this address and 55 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 17
Nearest to this location (20)
See all 73New Haven, CT 06513
New Haven, CT 06513
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate for Provider-Performed Microscopy Procedures (PPMP) 07D0098713
Fair Haven Community Health Clinic, Inc · New Haven, CTFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Fair Haven Community Health Clinic Inc's NPI number?
The NPI number for Fair Haven Community Health Clinic Inc is 1104803444. It was assigned to this organization in the NPPES registry on December 28, 2005.
Where is Fair Haven Community Health Clinic Inc located?
Fair Haven Community Health Clinic Inc is located at 374 Grand Ave, New Haven, CT 06513. The listed phone number is (203) 777-7411.
What is Fair Haven Community Health Clinic Inc's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is Fair Haven Community Health Clinic Inc enrolled in Medicare?
Yes. Fair Haven Community Health Clinic Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Fair Haven Community Health Clinic Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 73 clinicians in 17 Medicare specialties reassign their Medicare billing to Fair Haven Community Health Clinic Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (20), Clinical Social Worker (10) and Mental Health Counselor (10). Of these, 29 practice at this address and 55 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Fair Haven Community Health Clinic Inc hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 07D0098713) is associated with this NPI, valid through November 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Fair Haven Community Health Clinic Inc was last updated on October 30, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Fair Haven Community Health Clinic Inc · NPI 1104803444
Federally Qualified Health Center (FQHC) organization in New Haven, Connecticut. Organization record, active in the CMS NPPES registry since December 28, 2005.
## Identity
- **NPI:** 1104803444 (Entity type: Organization)
- **Enumerated:** December 28, 2005
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Organization subpart:** No
- **Authorized official:** Suzanne Lagarde, CEO
## Practice location
- **Address:** 374 GRAND AVE, New Haven, CT 06513
- **Phone:** (203) 777-7411 · **Fax:** (203) 777-8506
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 73 clinicians in 17 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (20), Clinical Social Worker (10), Mental Health Counselor (10); 29 practice at this address and 55 within 10 miles; [full list](https://npiprofile.com/npi/1104803444/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 30, 2014
- **Other identifiers:** Medicare PIN 071817 (CT); Medicaid 004235736 (CT)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104803444) · Data from the CMS NPPES public registry.