Organization
CODAC INC
Active
Other names
Codac East Bay
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALISHA M BOURDEAU BS (CFO)
(401) 275-5038
Entity
Organization
Contact information
Practice address
850 WATERMAN AVE, CODAC EAST BAY, EAST PROVIDENCE, RI 02914
(401) 434-4999
(401) 434-6116
Mailing address
1052 PARK AVE, CRANSTON, RI 02910
(401) 275-5038
(401) 942-3590
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
ACF01632-03
RI
251K00000X
Public Health or Welfare Agency
605.2
RI
261QM2800X
Methadone Clinic
Primary
605.02
RI
261QM2800X
Methadone Clinic
605.2
RI
261QP2300X
Primary Care Clinic/Center
ACF01632-03
RI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
605.02
RI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
605.2
RI
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
605.2
RI
Other
Enumeration date
04/18/2007
Last updated
12/21/2021
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