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Organization

CODAC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ALISHA M BOURDEAU (CFO)
(401) 275-5038
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
CO71983
RI
Enumeration date
02/22/2018
Last updated
04/25/2019
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