CODAC INC NPI 1467988683

NPI Information

NPI: 1467988683
Provider Name: CODAC INC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
1052 PARK AVE
CRANSTON, RI
ZIP 02910
Phone: (401) 275-5038
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CODAC INC is a rehabilitation and substance use disorder clinic center in Cranston, RI. CODAC INC NPI is 1467988683. The provider is registered as an organization entity type.

The provider's business location address is:

1052 PARK AVE
CRANSTON, RI
ZIP 02910-225
Phone: (401) 275-5038
Fax: (401) 942-3590

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 5/8/2017 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	261QP2300X	Clinic/Center	Primary Care	ACF01632	RHODE ISLAND	No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	ACF01632	RHODE ISLAND	Yes
3	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	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: 5/5/2024

NPI Synchronization or Removal

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