Healthcare Provider Details

I. General information

NPI: 1063337350
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 NEW BRITAIN AVE
HARTFORD CT
06106-3305
US

IV. Provider business mailing address

15 SEQUIN RD
WEST HARTFORD CT
06117-2248
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA D BOUSTANI
Title or Position: INTERN
Credential:
Phone: 860-808-4290