{"npi":"1104803444","type":"NPI-2","status":"active","name":{"display":"Fair Haven Community Health Clinic INC","other":[],"organization_name":"FAIR HAVEN COMMUNITY HEALTH CLINIC INC","authorised_official":"Suzanne Lagarde"},"specialty":{"primary_taxonomy":"261QF0400X","primary_taxonomy_description":"Federally Qualified Health Center","slug":"fqhc","schema_org_specialty":"PrimaryCare","all":[{"code":"124Q00000X","description":"Dental Hygienist","primary":false,"state":null,"license":null},{"code":"1223G0001X","description":"General Practice Dentistry","primary":false,"state":null,"license":null},{"code":"176B00000X","description":"Midwife","primary":false,"state":null,"license":null},{"code":"261QF0400X","description":"Federally Qualified Health Center","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"374 GRAND AVE","city":"NEW HAVEN","state":"CT","postal_code":"06513","country_code":"US","phone":"2037777411","fax":"2037778506"},{"purpose":"MAILING","street_1":"374 GRAND AVE","city":"NEW HAVEN","state":"CT","postal_code":"06513","country_code":"US","phone":"2037777411","fax":"2037778506"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"004235736","state":"CT","issuer":null}],"pecos":{"enrolled_at":"2026-07-01T15:01:53.235063+00:00","enrollments":[{"enrlmt_id":"O20040302000135","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20081121000689","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20090122000080","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20090122000167","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20130716000882","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20130719000549","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20130724000073","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20150105001271","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20180212000572","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20180212000696","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20180212001946","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20200422001095","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20230215003023","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20230217002650","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20230705002609","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20231221001330","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"},{"enrlmt_id":"O20240209001442","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"CT","pac_id":"4183511538"}]},"enumeration_date":"2005-12-28","last_updated":"2014-10-30","_meta":{"source":"NPPES","snapshot_date":"2014-10-30","doc_url":"https://findmynpi.com/api"}}