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Active NPI 1558712034 Organization (Entity Type 2)

Codac Inc

Clinic/Center - Methadone • Providence, RI

About Codac Inc NPI 1558712034 Summary

Codac Inc is a verified healthcare organization specializing in Clinic/Center - Methadone operating in Providence, RI. Located at 528 N MAIN ST, this facility provides patient care and medical services under National Provider Identifier (NPI) 1558712034.

Administrative operations and authorized compliance are overseen by Alisha Bourdeau (Cfo).

The facility is associated with 20 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

528 N Main St

Providence, RI 029045757

Telephone 4018084278
Fax 4018086957

Authorized Official Information

Authorized Contact Name

Alisha Bourdeau , BS

Title / Role

Cfo

Official Telephone

4012755038

Facility Classifications & Specialties

Clinic/Center - Methadone Primary Taxonomy

NUCC Taxonomy Code: 261QM2800X

An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

Public Health or Welfare

NUCC Taxonomy Code: 251K00000X

Definition to come...

Clinic/Center - Health Service

NUCC Taxonomy Code: 261QH0100X

Definition to come...

Peer Specialist

NUCC Taxonomy Code: 175T00000X

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Clinic/Center - Primary Care

NUCC Taxonomy Code: 261QP2300X

Definition to come...

Clinic/Center - Rehabilitation, Substance Use Disorder

NUCC Taxonomy Code: 261QR0405X

Definition to come...

Rehabilitation, Substance Use Disorder Unit

NUCC Taxonomy Code: 276400000X

A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoactive substance use disorders (commonly referred to as alcohol and drug abuse or substance abuse.)

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

20 Linked
James Richardson NPI 1063838308

Counselor

Providence, RI

View Practitioner Profile →
Cynthia Barry , LCSW NPI 1164753992

Social Worker

Providence, RI

View Practitioner Profile →
Kayla Lucia NPI 1174993968

Counselor - Mental Health

Providence, RI

View Practitioner Profile →
Luanne Calvo , LCSW NPI 1205086956

Social Worker

Providence, RI

View Practitioner Profile →

Surgery

Providence, RI

View Practitioner Profile →
Erin Clements , LCSW NPI 1265850895

Social Worker - Clinical

Providence, RI

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

11 Historical Events
NPI Profile Active September 25, 2017

NPI status registered as active in NPPES database

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Updated Practice Location September 25, 2017

Registered at 528 N MAIN ST, PROVIDENCE, RI 029045757 (Tel: 4018084278)

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Updated Business Mailing Address September 25, 2017

Registered at 1052 PARK AVE, CRANSTON, RI 029103225 (Tel: 4012755039)

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Organization / Clinic Name Updated September 25, 2017

Operating as CODAC INC

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 25, 2017

Public Health or Welfare (License #605.07 in RI)

NPI Profile Active June 29, 2016

NPI status registered as active in NPPES database

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Updated Practice Location June 29, 2016

Registered at 528 N MAIN ST, PROVIDENCE, RI 029045757 (Tel: 4018084278)

📍
Updated Business Mailing Address June 29, 2016

Registered at 1052 PARK AVE, CRANSTON, RI 029103225 (Tel: 4012755039)

🏛️
Organization / Clinic Name Updated June 29, 2016

Operating as CODAC INC

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 29, 2016

Clinic/Center (License #605.07 in RI)

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Initial NPI Registration & Enumeration June 27, 2016

First registered as active Healthcare Organization in NPPES Database.

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NPI Organization Metadata

NPI Number: 1558712034
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: June 27, 2016
Last Update: April 25, 2019

Mailing Address

1052 Park Ave

Cranston, RI 029103225

Phone: 4012755039

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.