Organization
CODAC INC
Active
Other names
CODAC Pawtucket Ave
Organization subpart
No
Provider details
NPI number
Authorized official
ALISHA M BOURDEAU (CFO)
(401) 275-5038
Entity
Organization
Contact information
Practice address
600 PAWTUCKET AVE, PAWTUCKET, RI 02860-6059
(401) 808-6278
(401) 808-6957
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
—
—
261QM2800X
Methadone Clinic
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CO71983
—
RI
Enumeration date
04/25/2019
Last updated
12/21/2021
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