# CODAC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164923553
- **Authorized official:** ALISHA M BOURDEAU (CFO)
- **Authorized official phone:** (401) 275-5038

## Contact information

- **Practice address:** 3 REGAN CT, CRANSTON, RI 02920
- **Practice address phone:** (401) 462-3530
- **Practice address fax:** (401) 462-3529
- **Mailing address:** 1052 PARK AVE, CRANSTON, RI 02910-3225
- **Mailing address phone:** (401) 275-5038
- **Mailing address fax:** (401) 942-3590

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 175T00000X | Peer Specialist | — | NULL | — |
| 175T00000X | Peer Specialist | — | — | — |
| 251K00000X | Public Health or Welfare Agency | 605.08 | RI | Yes |
| 261QM2800X | Methadone Clinic | 605.08 | RI | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | 605.08 | RI | — |

## Other

- **Enumeration date:** 02/22/2018
- **Last updated:** 04/25/2019