CODAC INC NPI 1558712034

NPI Information

NPI: 1558712034
Provider Name: CODAC INC

Doing Business As: CODAC NORTH MAIN

Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

CLIA Number: 41D2064052

Address:
528 N MAIN ST
PROVIDENCE, RI
ZIP 02904
Phone: (401) 808-4278
Get Directions

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 1558712034. The provider is registered as an organization entity type.
The provider Is Doing Business As Codac North Main.

The provider's business location address is:

528 N MAIN ST
PROVIDENCE, RI
ZIP 02904-757
Phone: (401) 808-4278
Fax: (401) 808-6957

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

The CLIA number assigned to this NPI record is 41D2064052 - other - opioid treatment with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/27/2016 and was last updated on 4/25/2019.

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	251K00000X	Public Health or Welfare		605.07	RHODE ISLAND	No
2	261QH0100X	Clinic/Center	Health Service	605.07	RHODE ISLAND	No
3	261QP2300X	Clinic/Center	Primary Care	ACF01632	RHODE ISLAND	No
4	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	605.07	RHODE ISLAND	No
5	276400000X	Rehabilitation, Substance Use Disorder Unit		605.07	RHODE ISLAND	No
6	175T00000X	Peer Specialist				No
7	261QM2800X	Clinic/Center	Methadone	605.07	RHODE ISLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CI01382	MEDICAID	RHODE ISLAND

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: 4/28/2024

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