CODAC INC (NPI# 1679799217) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679799217 |
| Entity Type | Organization |
| Organization Name | CODAC INC |
| Other Organization Name | CODAC SOUTH COUNTY |
| Practice Address |
350 Columbia St Codac South County Wakefield RI 02879 |
| Mailing Address |
1052 Park Ave Cranston RI 02910 |
| Practice Telephone | 4017890934 |
| Practice Fax Number | 4017890251 |
| 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 |
ACF01632-02 | RI | Allopathic & Osteopathic Physicians |
| N | 251K00000X | Public Health or Welfare | 605.6 | RI | Agencies |
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.6 | RI | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ACF01632-02 | RI | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.6 | RI | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.06 | RI | Ambulatory Health Care Facilities |
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.06 | RI | Ambulatory Health Care Facilities |
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | 605.6 | RI | Hospital Units |
| Other Name | Type Code |
|---|---|
| Codac South County | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164923553 | Codac Inc | Peer Specialist | 3 Regan Ct, Cranston, RI 02920 | 2018-02-22 |
| 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 |
| 1043436785 | Codac Inc | Peer Specialist | 93 Thames St, Codac Newport, Newport, RI 02840 | 2007-04-18 |
| Street Address |
350 COLUMBIA ST CODAC SOUTH COUNTY |
| City | WAKEFIELD |
| State | RI |
| Zip Code | 02879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386041200 | Courtney Wood | Counselor | 350 Columbia St, Wakefield, RI 02879-2494 | 2014-11-20 |
| 1396141644 | Gregory Andersen Sr. | Counselor | 350 Columbia St, Wakefield, RI 02879-2494 | 2014-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831549435 | Bh Brightview Commons Opco, LLC | Alzheimer Center (Dementia Center) | 57 Grandeville Court, Wakefield, RI 02879 | 2016-06-15 |
| 1215392071 | Leslie Healy | Occupational Therapist | 12 Galleon Ct, Wakefield, RI 02879 | 2015-12-22 |
| 1649673799 | Peter Storti | Clinic/Center | 28 Columbia Street, Wakefield, RI 02879 | 2014-10-03 |
| 1285988790 | Silver Spring Health Care Management, Inc. | Physician Assistant | 70 Kenyon Ave Unit 321, Wakefield, RI 02879 | 2012-11-06 |
| 1013271584 | Amy Lee Barker | Speech-Language Pathologist | 213 Robinson Street, Wakefield, RI 02879 | 2012-06-29 |
| 1366708489 | Paige Houlihan | Student in an Organized Health Care Education/Training Program | 91 Rocky Brook Way St, Wakefield, RI 02879 | 2012-04-03 |
| 1639307176 | Perspectives Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 53 Dockray Street, Wakefield, RI 02879 | 2009-06-23 |
| 1649482233 | Marilyn A. Cooney | Speech-Language Pathologist | 307 Curtis Corner Road, Wakefield, RI 02879 | 2007-05-04 |
| 1518184522 | Keeley Therese Dante-card | Registered Nurse | 55 Cherry Lane, Wakefield, RI 02879 | 2007-04-19 |
| 1336261171 | Paul D Cashion | Dentist | 45 Patton Ave, Wakefield, RI 02879 | 2007-04-04 |
| Find all providers in zip 02879 | ||||
| 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.