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Organization
CODAC INC
Active
Organization
CODAC INC
Active
Other names
CODAC North Main
Organization subpart
No
Provider details
NPI number
Authorized official
ALISHA BOURDEAU BS (CFO)
(401) 275-5038
Entity
Organization
Contact information
Practice address
528 N MAIN ST, PROVIDENCE, RI 02904-5757
(401) 808-4278
(401) 808-6957
Mailing address
1052 PARK AVE, CRANSTON, RI 02910-3225
(401) 275-5039
(401) 942-3590
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
251K00000X
Public Health or Welfare Agency
605.07
RI
261QH0100X
Health Service Clinic/Center
605.07
RI
261QM2800X
Methadone Clinic
Primary
605.07
RI
261QP2300X
Primary Care Clinic/Center
ACF01632
RI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
605.07
RI
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
605.07
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CI01382
—
RI
Enumeration date
06/27/2016
Last updated
04/25/2019
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