CODAC INC (NPI# 1629632609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629632609 |
| Entity Type | Organization |
| Organization Name | CODAC INC |
| Practice Address |
600 Pawtucket Ave Pawtucket RI 02860-6059 |
| Mailing Address |
1052 Park Ave Cranston RI 02910-3225 |
| Practice Telephone | 4018086278 |
| Practice Fax Number | 4018086957 |
| Mailing Telephone | 4012755038 |
| Mailing Fax Number | 4019423590 |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2019-04-25 |
| Authorized Official Name | ALISHA M BOURDEAU (CFO) |
| Authorized Official Telephone | 4012755038 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 175T00000X | Peer Specialist | Other Service Providers | ||
| N | 251K00000X | Public Health or Welfare | Agencies | ||
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| N | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
Ambulatory Health Care Facilities | ||
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities | ||
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | CO71983 | 05 |
| Other Name | Type Code |
|---|---|
| CODAC Pawtucket Ave | 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 |
| 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 |
600 PAWTUCKET AVE |
| City | PAWTUCKET |
| State | RI |
| Zip Code | 02860-6059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659390813 | Rhode Island Spine Center Inc | Chiropractor | 600 Pawtucket Ave, Pawtucket, RI 02860 | 2006-07-19 |
| 1265440218 | Donald R Murphy | Chiropractor | 600 Pawtucket Ave, Pawtucket, RI 02860 | 2006-08-04 |
| 1760496426 | Josh T Randall | Physical Therapist | 600 Pawtucket Ave, Pawtucket, RI 02860 | 2006-07-28 |
| 1548282304 | Laura B Murphy | Chiropractor | 600 Pawtucket Ave, Pawtucket, RI 02860 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972096923 | Lmb Medical LLC | Internal Medicine | 127 School St, Pawtucket, RI 02860 | 2018-06-13 |
| 1215420435 | Tyla Jackson | Behavior Technician | 70 Wood St Apt 22, Pawtucket, RI 02860 | 2018-06-12 |
| 1376048637 | Michael A Iadevaia | Family Medicine | 111 Brewster St Fl 3, Pawtucket, RI 02860 | 2018-03-28 |
| 1730690488 | Anthony Edwin Ramicone | Physician Assistant | 407 East Ave Ste 120, Pawtucket, RI 02860 | 2017-10-21 |
| 1669991352 | Kathleen K. Kroessler, Md; Neurology & Acupuncture, Inc. PC | Clinic/Center | 407 East Ave; Suite 110, Pawtucket, RI 02860 | 2017-09-13 |
| 1841716230 | Ri Alternative Academy Management, LLC | Local Education Agency (LEA) | 249 Roosevelt Avenue, Pawtucket, RI 02860 | 2017-08-17 |
| 1396265724 | Hannah R Stoops | Family Medicine | 111 Brewster St Fcc A, Pawtucket, RI 02860 | 2017-06-27 |
| 1427578400 | Shaun Michael Flynn | Family Medicine | 111 Brewster St, Fcc A, Pawtucket, RI 02860 | 2017-06-21 |
| 1073051843 | Laura Jane Amaral | Counselor | 750 East Ave Unit 1e, Pawtucket, RI 02860 | 2017-02-01 |
| 1063862027 | Stephanie Shoppell | Counselor | 105 Bacon Street, Pawtucket, RI 02860 | 2016-06-20 |
| Find all providers in zip 02860 | ||||
| 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
Please comment or provide details below to improve the information on CODAC INC.
| 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.