Organization
CODAC INC
Active
Organization
CODAC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALISHA M BOURDEAU (CFO)
(401) 275-5038
Entity
Organization
Contact information
Practice address
50 HEALTH LN, WARWICK, RI 02886-2711
(401) 384-7300
(401) 384-7483
Mailing address
1052 PARK AVE, CRANSTON, RI 02910-3225
(401) 275-5038
(401) 942-3590
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
261QM2800X
Methadone Clinic
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CO71983
—
RI
Enumeration date
03/20/2021
Last updated
06/11/2025
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