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NPI Code Detail

MEDICARE: CODAC INC

MEDICARE: CODAC INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2251K00000XPublic Health or Welfare Agency605RI
3261QM2800XMethadone Clinic605.00RI
4261QP2300XPrimary Care Clinic/CenterACF01632RI
5276400000XSubstance Use Disorder Rehabilitation Hospital Unit605RI
6175T00000XPeer Specialist
7207QA0401XAddiction Medicine (Family Medicine) Physician605.00RI
8207RC0000XCardiovascular Disease Physician605.00RI
9276400000XSubstance Use Disorder Rehabilitation Hospital Unit
10261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center605.0RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851513394
Entity Type Code : Organization
Provider Name (Legal Business Name) : CODAC INC
Provider Business Mailing Address
First Line : 1052 PARK AVE
Second Line :
City : CRANSTON
State : RI
Zip : 02910-3225
Country : US
Telephone Number : 401-275-5038
Fax Number : 401-942-3590
Provider Business Practice Location Address
First Line : 1052 PARK AVE
Second Line :
City : CRANSTON
State : RI
Zip : 02910-3225
Country : US
Telephone Number : 401-275-5038
Fax Number : 401-942-3590
Authorized Official
Title or Position : CFO
Name : ALISHA M BOURDEAU
Credential :
Telephone Number : 401-275-5038
Provider Enumeration Date : 05/03/2007
Last Update Date : 01/13/2025

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1972626760 — MRS. LAURA E LEVINE MHC
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1710109848 — MS. JANE F DILORENZO LCDP
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Directions to “CODAC INC ” Practice Location

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