CODAC INC NPI 1215153945

NPI Information

NPI: 1215153945
Provider Name: CODAC INC
Classification: Clinic/Center - 261QM2800X
Specialization: Methadone
Entity Type: Organization
Doing Business As: CODAC PROVIDENCE
Address: 349 HUNTINGTON AVE
CODAC PROVIDENCE
PROVIDENCE, RI
ZIP 02909
Phone: (401) 942-1450

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NPI Details

CODAC INC is a methadone clinic center in Providence, RI. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. CODAC INC NPI is 1215153945. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Codac Providence.

The provider's business location address is:

349 HUNTINGTON AVE
CODAC PROVIDENCE
PROVIDENCE, RI
ZIP 02909
Phone: (401) 942-1450
Fax: (401) 946-1550

The provider's authorized official is Alisha M Bourdeau .
The authorized official title is Cfo and has the following contact phone number (401) 275-5038.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm (HCPCS:G2067)
Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure (HCPCS:G2078)
Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) (HCPCS:G2074)

The enumeration date for this NPI number is 4/18/2007 and was last updated on 12/21/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0401X	Family Medicine	Addiction Medicine	ACF01632	RHODE ISLAND	No
2	251K00000X	Public Health or Welfare		605.5	RHODE ISLAND	No
3	261QM2800X	Clinic/Center	Methadone	605.05	RHODE ISLAND	Yes
4	261QM2800X	Clinic/Center	Methadone	605.5	RHODE ISLAND	No
5	261QP2300X	Clinic/Center	Primary Care	ACF01632	RHODE ISLAND	No
6	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	605.05	RHODE ISLAND	No
7	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	605.5	RHODE ISLAND	No
8	276400000X	Rehabilitation, Substance Use Disorder Unit		605.5	RHODE ISLAND	No
9	175T00000X	Peer Specialist				No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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