CODAC INC (NPI# 1043436785) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043436785 |
| Entity Type | Organization |
| Organization Name | CODAC INC |
| Other Organization Name | CODAC NEWPORT |
| Practice Address |
93 Thames St Codac Newport Newport RI 02840 |
| Mailing Address |
1052 Park Ave Cranston RI 02910 |
| Practice Telephone | 4018464150 |
| Practice Fax Number | 4018469340 |
| Mailing Telephone | 4012755038 |
| Mailing Fax Number | 4019423590 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2019-04-25 |
| Authorized Official Name | MS. ALISHA M BOURDEAU (CFO) |
| Authorized Official Telephone | 4012755038 |
| Authorized Official Credential | BS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 175T00000X | Peer Specialist | Other Service Providers | ||
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
ACF01632-05 | RI | Allopathic & Osteopathic Physicians |
| N | 251K00000X | Public Health or Welfare | 605.4 | RI | Agencies |
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.4 | RI | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ACF01632-05 | RI | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.4 | RI | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.04 | RI | Ambulatory Health Care Facilities |
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | 605.4 | RI | Hospital Units |
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.04 | RI | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Codac Newport | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164923553 | Codac Inc | Peer Specialist | 3 Regan Ct, Cranston, RI 02920 | 2018-02-22 |
| 1679799217 | Codac Inc | Peer Specialist | 350 Columbia St, Codac South County, Wakefield, RI 02879 | 2007-04-18 |
| 1215153945 | Codac Inc | Peer Specialist | 349 Huntington Ave, Codac Providence, Providence, RI 02909 | 2007-04-18 |
| 1295731321 | Codac Inc | Clinic/Center | 1052 Park Ave, Codac Cranston, Cranston, RI 02910 | 2005-06-23 |
| 1629632609 | Codac Inc | Peer Specialist | 600 Pawtucket Ave, Pawtucket, RI 02860-6059 | 2019-04-25 |
| 1467988683 | Codac Inc | Peer Specialist | 1052 Park Ave, Cranston, RI 02910-3225 | 2017-05-08 |
| 1558712034 | Codac Inc | Public Health or Welfare | 528 N Main St, Providence, RI 02904-5757 | 2016-06-27 |
| 1851513394 | Codac Inc | Peer Specialist | 1052 Park Ave, Cranston, RI 02910-3225 | 2007-05-03 |
| 1376769919 | Codac Inc | Clinic/Center | 850 Waterman Ave, Codac East Bay, East Providence, RI 02914 | 2007-04-18 |
| Street Address |
93 THAMES ST CODAC NEWPORT |
| City | NEWPORT |
| State | RI |
| Zip Code | 02840 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275601056 | Michael Anthony Mcgourty | Physician Assistant | 93 Thames St, Newport, RI 02840-2536 | 2006-12-01 |
| 1356780696 | Andrea Tonski | Counselor | 93 Thames St, Newport, RI 02840-2536 | 2013-06-20 |
| 1710126305 | John P Feld | Counselor | 93 Thames St, Newport, RI 02840-2536 | 2009-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164993465 | Jacquelene Henderson | Counselor | 1341 West Main Road, Suite 16, Newport, RI 02840 | 2018-12-12 |
| 1619406683 | Lauren A Mcgovern | Social Worker | 8 Freebody St Ste 101, Newport, RI 02840 | 2017-06-05 |
| 1922388289 | Newport Family Foot Care, LLC | Podiatrist | 329 Broadway, Newport, RI 02840 | 2011-08-18 |
| 1578867255 | Nora K Griscom | Social Worker | 130 Bellevue Ave Ste 214, Newport, RI 02840 | 2011-01-10 |
| 1528200326 | Jessica Marie Welsh | Speech-Language Pathologist | 10 Friendship Street, Newport, RI 02840 | 2009-03-25 |
| 1023139037 | Elizabeth J Hayes | Counselor | Codac Inc, 93 Thames St, Newport, RI 02840 | 2007-04-03 |
| 1265551105 | Richatd Stengel | Dentist | East Bay Community Action Program, 19 Broadway, Newport, RI 02840 | 2007-03-29 |
| 1235262346 | Jon E Brett | Psychologist | 37 Powel Avenue, Newport, RI 02840 | 2007-03-14 |
| 1710018668 | James L Maher Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 120 Hillside Ave, Newport, RI 02840 | 2007-03-09 |
| 1285760736 | John Louis Salomone | Dentist | 73 Memorial Blvd, Newport, RI 02840 | 2007-02-26 |
| Find all providers in zip 02840 | ||||
| Taxonomy Code | 261QM2800X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Methadone Clinic |
| An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902467913 | New Hope Treatment Center of Tennessee LLC | Clinic/Center | 135 Fox and Hound Way, Newport, TN 37821-8074 | 2019-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699795104 | Center for Treatment and Recovery | Clinic/Center | 82 Pond Street, Pawtucket, RI 02860 | 2006-07-20 |
| 1053319368 | R.i.s.a.t., LLC | Clinic/Center | 1625 Diamond Hill Rd, Woonsocket, RI 02895-1541 | 2005-07-11 |
| 1457822413 | Victa LLC | Clinic/Center | 110 Elmwood Ave, Providence, RI 02907-2423 | 2018-12-16 |
| 1750631990 | Sheila Smith | Clinic/Center | 1625 Diamond Hill Rd, Woonsocket, RI 02895-1771 | 2012-09-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.