CODAC INC (NPI# 1295731321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295731321 |
| Entity Type | Organization |
| Organization Name | CODAC INC |
| Other Organization Name | CODAC CRANSTON |
| Practice Address |
1052 Park Ave Codac Cranston Cranston RI 02910 |
| Mailing Address |
1052 Park Ave Cranston RI 02910 |
| Practice Telephone | 4014615056 |
| Practice Fax Number | 4019432167 |
| Mailing Telephone | 4012755038 |
| Mailing Fax Number | 4019423590 |
| Enumeration Date | 2005-06-23 |
| 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 | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.01 | RI | Ambulatory Health Care Facilities |
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | 605.1 | RI | Hospital Units |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ACF01632-01 | RI | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.1 | RI | Ambulatory Health Care Facilities |
| N | 175T00000X | Peer Specialist | Other Service Providers | ||
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
ACF01632-0 | RI | Allopathic & Osteopathic Physicians |
| N | 251K00000X | Public Health or Welfare | 605.1 | RI | Agencies |
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.01 | RI | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Codac Cranston | 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 |
| 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 |
| 1043436785 | Codac Inc | Peer Specialist | 93 Thames St, Codac Newport, Newport, RI 02840 | 2007-04-18 |
| Street Address |
1052 PARK AVE CODAC CRANSTON |
| City | CRANSTON |
| State | RI |
| Zip Code | 02910 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467988683 | Codac Inc | Peer Specialist | 1052 Park Ave, Cranston, RI 02910-3225 | 2017-05-08 |
| 1497144752 | Ileana Santiago | Counselor | 1052 Park Ave, Cranston, RI 02910-3225 | 2015-01-09 |
| 1780082743 | Codac Behavioral Healthcare | Community/Behavioral Health | 1052 Park Ave, Cranston, RI 02910-3225 | 2014-12-08 |
| 1427454453 | Jessica Elliott | Counselor | 1052 Park Ave, Cranston, RI 02910-3225 | 2014-11-19 |
| 1316196900 | Margarida A Renzi | Counselor | 1052 Park Ave, Cranston, RI 02910-3225 | 2008-09-18 |
| 1629249156 | Tammy Brown | Counselor | 1052 Park Ave, Cranston, RI 02910-3225 | 2008-03-12 |
| 1851513394 | Codac Inc | Peer Specialist | 1052 Park Ave, Cranston, RI 02910-3225 | 2007-05-03 |
| 1710109848 | Jane F Dilorenzo | Counselor | 1052 Park Ave, Cranston, RI 02910-3225 | 2007-05-02 |
| 1023043056 | Susan H Hart | Internal Medicine | 1052 Park Ave, Cranston, RI 02910-3225 | 2006-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417443441 | Luis Guzman | Durable Medical Equipment & Medical Supplies | 29 Rolfe Square, Cranston, MA 02910 | 2018-07-02 |
| 1023535010 | Sarah Pagliarini | Nurse Practitioner | 725 Reservoir Ave Ste 308, Cranston, RI 02910 | 2017-08-29 |
| 1861890105 | Marissa Falco | Counselor | 1471 Elmwood Avenue, Cranston, RI 02910 | 2014-12-19 |
| 1952702425 | Lauren Beth Shibley | Counselor | 825 Pontiac Avenue Apt 14101, Cranston, RI 02910 | 2014-09-15 |
| 1831516632 | Kelly Kilmartin | Counselor | 471 Elmwood Avenue, Cranston, RI 02910 | 2014-03-19 |
| 1376784827 | Michael Eric Schaffer | Counselor | 989 Reservoir Ave Ste 104, Cranston, RI 02910 | 2009-03-13 |
| 1639384829 | Dolores Maiello Ciambrone | Social Worker | 145 Harmon Ave, Cranston, RI 02910 | 2007-05-11 |
| 1750502241 | Mary Jane Boucher | Counselor | Codac Cranston, 1052 Park Ave, Cranston, RI 02910 | 2007-05-01 |
| 1134250715 | Michele Bailey Chaudhry | Social Worker | 935 Reservoir Ave, Cranston, RI 02910 | 2007-03-08 |
| 1487703658 | Karen M Mega | Dentist | 567 Reservoir Ave, Cranston, RI 02910 | 2007-01-09 |
| Find all providers in zip 02910 | ||||
| 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 |
|---|---|---|---|---|
| 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.