Organization
CODAC INC
Active
Organization
CODAC INC
Active
Other names
Codac Corporate, Codac Behavioral Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
ALISHA M BOURDEAU (CFO)
(401) 275-5038
Entity
Organization
Contact information
Practice address
1052 PARK AVE, CRANSTON, RI 02910-3225
(401) 275-5038
(401) 942-3590
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
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
605.00
RI
207RC0000X
Cardiovascular Disease Physician
605.00
RI
251B00000X
Case Management Agency
—
—
251K00000X
Public Health or Welfare Agency
605
RI
261QM2800X
Methadone Clinic
605.00
RI
261QP2300X
Primary Care Clinic/Center
ACF01632
RI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
605.0
RI
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
605
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CI01382
—
RI
Enumeration date
05/03/2007
Last updated
01/13/2025
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