CODAC INC (NPI# 1376769919) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376769919 |
| Entity Type | Organization |
| Organization Name | CODAC INC |
| Other Organization Name | CODAC EAST BAY |
| Practice Address |
850 Waterman Ave Codac East Bay East Providence RI 02914 |
| Mailing Address |
1052 Park Ave Cranston RI 02910 |
| Practice Telephone | 4014344999 |
| Practice Fax Number | 4014346116 |
| 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 | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ACF01632-03 | RI | Ambulatory Health Care Facilities |
| N | 175T00000X | Peer Specialist | Other Service Providers | ||
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
ACF01632-03 | RI | Allopathic & Osteopathic Physicians |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.2 | RI | Ambulatory Health Care Facilities |
| N | 251K00000X | Public Health or Welfare | 605.2 | RI | Agencies |
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.2 | RI | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.02 | RI | Ambulatory Health Care Facilities |
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | 605.2 | RI | Hospital Units |
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.02 | RI | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Codac East Bay | 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 |
| 1043436785 | Codac Inc | Peer Specialist | 93 Thames St, Codac Newport, Newport, RI 02840 | 2007-04-18 |
| Street Address |
850 WATERMAN AVE CODAC EAST BAY |
| City | EAST PROVIDENCE |
| State | RI |
| Zip Code | 02914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972626760 | Laura E Levine | Counselor | 850 Waterman Ave, Codac Inc, East Providence, RI 02914 | 2007-04-09 |
| 1700420122 | Kristina Marie Micheli | Counselor | 850 Waterman Ave, East Providence, RI 02914-1729 | 2019-10-29 |
| 1205307931 | Marla K Pasqua | Counselor | 850 Waterman Ave, East Providence, RI 02914-1729 | 2018-12-06 |
| 1750866638 | Megan Cordeiro Ferreira | Counselor | 850 Waterman Ave, East Providence, RI 02914-1729 | 2018-09-26 |
| 1811411457 | Rebecca Lynn Brown | Counselor | 850 Waterman Ave, East Providence, RI 02914-1729 | 2017-07-26 |
| 1558767236 | Michael Bettencourt | Counselor | 850 Waterman Ave, East Providence, RI 02914-1729 | 2014-11-07 |
| 1518137058 | Lauranne Howard | Counselor | 850 Waterman Ave, East Providence, RI 02914-1729 | 2008-03-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457988198 | Sean C. Duffy | Massage Therapist | 231 Warren Ave., East Providence, RI 02914 | 2020-03-24 |
| 1457905606 | Jeanine Le-kreuzer, Lmhc | Clinic/Center | 3421 Pawtucket Ave, East Providence, RI 02914 | 2019-07-26 |
| 1881113983 | Megan Grace Fitzpatrick | Student in an Organized Health Care Education/Training Program | 51 Milburn Rd, East Providence, RI 02914 | 2017-09-11 |
| 1265719660 | Hilary Elise Bicknell | Physical Therapist | 927 B Warren Ave, East Providence, RI 02914 | 2011-11-14 |
| 1346549037 | Amanda M Hope | Occupational Therapist | 2680 Pawtucket Ave, East Providence, RI 02914 | 2011-03-21 |
| 1780993824 | Shannon Hayes | Physical Therapist | 400 Massaoit Ave, East Providence, RI 02914 | 2010-10-06 |
| 1053623538 | Ricardo Rafael Correa Marquez | Internal Medicine | 900 Warren Avenue, Suite 300, East Providence, RI 02914 | 2010-07-13 |
| 1013231570 | Michael Seidler | Internal Medicine | 20 Catamore Blvd., East Providence, RI 02914 | 2010-03-26 |
| 1053543405 | Ray Rezania | Dentist | 1055 South Broadway, East Providence, RI 02914 | 2009-08-19 |
| 1144464587 | John F Maynard | Urology | Metacomet Office Park, 450 Veterans Parkway, East Providence, RI 02914 | 2009-04-29 |
| Find all providers in zip 02914 | ||||
| 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 |
| City | EAST PROVIDENCE |
| Zip Code | 02914 |
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.