CODAC INC (NPI# 1851513394) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851513394 |
| Entity Type | Organization |
| Organization Name | CODAC INC |
| Other Organization Name | CODAC CORPORATE |
| Practice Address |
1052 Park Ave Cranston RI 02910-3225 |
| Practice Telephone | 4012755038 |
| Practice Fax Number | 4019423590 |
| Mailing Telephone | 4012755038 |
| Mailing Fax Number | 4019423590 |
| Enumeration Date | 2007-05-03 |
| 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 |
605.00 | RI | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
605.00 | RI | Allopathic & Osteopathic Physicians |
| N | 251K00000X | Public Health or Welfare | 605 | RI | Agencies |
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
605.00 | RI | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ACF01632 | RI | Ambulatory Health Care Facilities |
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | 605 | RI | Hospital Units |
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | Hospital Units | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
605.0 | RI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | CI01382 | 05 |
| Other Name | Type Code |
|---|---|
| Codac Corporate | Other Name - Individual/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 |
| 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 |
| City | CRANSTON |
| State | RI |
| Zip Code | 02910-3225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 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 |
| 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 | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295731321 | Codac Inc | Clinic/Center | 1052 Park Ave, Codac Cranston, Cranston, RI 02910 | 2005-06-23 |
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| 1417955733 | Discovery House Utah | Clinic/Center | 88 W Warwick Ave, West Warwick, RI 02893-3871 | 2005-07-11 |
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| 1194292235 | Adcare Rhode Island | Clinic/Center | 600 Putnam Pike Ste 7, Greenville, RI 02828-1487 | 2018-10-26 |
| 1902373046 | Adcare Rhode Island | Clinic/Center | 11 King Charles Dr Ste A2, Portsmouth, RI 02871-1364 | 2018-10-26 |
| 1114430907 | Comprehensive Addiction Treatment LLC | Clinic/Center | 1950 Tower Hill Rd, N Kingstown, RI 02852-6639 | 2017-11-15 |
| 1376938654 | Vita Nova LLC | Clinic/Center | 66 Pavilion Ave, Providence, RI 02905-1522 | 2015-04-02 |
| 1023359122 | P and R Recovery Services LLC | Clinic/Center | 11 King Charles Dr, A2, Portsmouth, RI 02871-1446 | 2013-03-14 |
| 1629102579 | Thrive Behavioral Health | Clinic/Center | 50 Health Ln, Warwick, RI 02886-2711 | 2007-03-15 |
| Find all providers with the same taxonomy | ||||
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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.