CODAC INC NPI 1629632609

NPI Information

NPI: 1629632609
Provider Name: CODAC INC
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

Address:
600 PAWTUCKET AVE
PAWTUCKET, RI
ZIP 02860
Phone: (401) 808-6278
Get Directions

CODAC INC is a methadone clinic center in Pawtucket, 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 1629632609. The provider is registered as an organization entity type.

The provider's business location address is:

600 PAWTUCKET AVE
PAWTUCKET, RI
ZIP 02860-059
Phone: (401) 808-6278
Fax: (401) 808-6957

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 enumeration date for this NPI number is 4/25/2019 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	Primary
1	251K00000X	Public Health or Welfare		No
2	261QM2800X	Clinic/Center	Methadone	Yes
3	261QP2300X	Clinic/Center	Primary Care	No
4	261QR0400X	Clinic/Center	Rehabilitation	No
5	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	No
6	175T00000X	Peer Specialist		No

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	CO71983	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

NPI Synchronization or Removal

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