FAIR HAVEN COMMUNITY HEALTH CLINIC INC – Federally Qualified Health Center (FQHC), NPI 1104803444
Federally Qualified Health Center (FQHC)
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Fair Haven Health Clinic, 374, Grand Avenue, Mill River, Barnesville, New Haven, New Haven County, Connecticut, 06513, United States
NEW HAVEN, CT 06513
Phone: (203) 777-7411
Fax: (203) 777-8506
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-02-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1047 days ago).
Enrollment records
17
Earliest due date
2023-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040302000135 | O | Clinic/Group Practice | CT | TBD |
| O20081121000689 | O | Federally Qualified Health Center (Fqhc) | CT | 2023-07-31 |
| O20090122000080 | O | Federally Qualified Health Center (Fqhc) | CT | 2023-07-31 |
| O20090122000167 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20130716000882 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20130719000549 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20130724000073 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20150105001271 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20180212000572 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20180212000696 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20180212001946 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20200422001095 | O | Federally Qualified Health Center (Fqhc) | CT | 2025-07-31 |
| O20230215003023 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20230217002650 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20230705002609 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20231221001330 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
| O20240209001442 | O | Federally Qualified Health Center (Fqhc) | CT | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 06513)
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