CODAC INC (NPI# 1558712034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558712034 |
| Entity Type | Organization |
| Organization Name | CODAC INC |
| Other Organization Name | CODAC NORTH MAIN |
| Practice Address |
528 N Main St Providence RI 02904-5757 |
| Mailing Address |
1052 Park Ave Cranston RI 02910-3225 |
| Practice Telephone | 4018084278 |
| Practice Fax Number | 4018086957 |
| Mailing Telephone | 4012755039 |
| Mailing Fax Number | 4019423590 |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2019-04-25 |
| Authorized Official Name | ALISHA 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 | 251K00000X | Public Health or Welfare | 605.07 | RI | Agencies |
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
605.07 | RI | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ACF01632 | RI | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.07 | RI | Ambulatory Health Care Facilities |
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | 605.07 | RI | Hospital Units |
| N | 175T00000X | Peer Specialist | Other Service Providers | ||
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.07 | RI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | CI01382 | 05 |
| Other Name | Type Code |
|---|---|
| CODAC North Main | 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 |
| 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 |
528 N MAIN ST |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02904-5757 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881683985 | Arnold Harvey Herman | Surgery | 528 N Main St, Suite 3, Providence, RI 02904-5762 | 2005-10-20 |
| 1881220630 | John Vincent Gambino | Registered Nurse | 528 N Main St, Providence, RI 02904-5757 | 2020-03-12 |
| 1316506157 | Fallon Ellen Perreault | Counselor | 528 N Main St, Providence, RI 02904-5757 | 2019-06-06 |
| 1801358643 | Jora Ehrlich | Counselor | 528 N Main St, Providence, RI 02904-5757 | 2019-04-02 |
| 1346709029 | Stacey Leclerc | Counselor | 528 N Main St, Providence, RI 02904-5757 | 2019-03-13 |
| 1235625294 | Scott David Robinson | Registered Nurse | 528 N Main St, Providence, RI 02904-5757 | 2018-07-02 |
| 1548754484 | Rachel Armada | Social Worker | 528 N Main St, Providence, RI 02904-5770 | 2018-06-14 |
| 1801399449 | Gail Marie Moran | Registered Nurse | 528 N Main St, Providence, RI 02904-5757 | 2018-03-09 |
| 1255830816 | Vanessa Madrid | Registered Nurse | 528 N Main St, Providence, RI 02904-5757 | 2018-02-08 |
| 1619498664 | Shauna Mccafferty | Social Worker | 528 N Main St, Providence, RI 02904-5757 | 2017-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144792383 | Lifespan Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 180 Corliss Street, Suite A, Providence, RI 02904 | 2018-12-28 |
| 1780168229 | Beth M. Kalunian | Social Worker | 480 Charles Street, Providence, RI 02904 | 2018-09-20 |
| 1588161608 | Michael P. Johnson, Md, Inc | Internal Medicine | 148 W River St Ste 22b, Providence, RI 02904 | 2018-04-06 |
| 1780045948 | Fred Saccoccio | Pharmacist | 15 Smithfield Road, No Providence, RI 02904 | 2016-03-16 |
| 1699148999 | Latin Adult Day Health Care Center | Clinic/Center | 665 Charles Street, Providence, RI 02904 | 2015-11-09 |
| 1144639956 | Dina P Toolin | Occupational Therapist | 195 Collyer St. 3rd Floor, University Medical Center/miriam Hospital Outpatient, Providence, RI 02904 | 2014-08-06 |
| 1801208798 | Seth Clark | Internal Medicine | 200 Corliss St, Providence, RI 02904 | 2014-05-27 |
| 1134554645 | Molly Elizabeth Smith | Physical Therapist | 1405 Douglas Ave, North Providence, RI 02904 | 2013-09-04 |
| 1336408723 | Emad Awa | Pediatrics | 1 Randall Sq Ste 404, Providence, RI 02904 | 2012-05-07 |
| 1598036790 | Joseph F. Osmanski, Od, Inc | Optometrist | 1971 Mineral Spring Avenue, N. Providence, RI 02904 | 2012-01-19 |
| Find all providers in zip 02904 | ||||
| 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 |
|---|---|---|---|---|
| 1457822413 | Victa LLC | Clinic/Center | 110 Elmwood Ave, Providence, RI 02907-2423 | 2018-12-16 |
| 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 |
| 1750631990 | Sheila Smith | Clinic/Center | 1625 Diamond Hill Rd, Woonsocket, RI 02895-1771 | 2012-09-14 |
| City | PROVIDENCE |
| Zip Code | 02904 |
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.