Codac Healthcare, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

CODAC HEALTHCARE, LLC

Practice address

349 Huntington Ave
Providence, RI 02909-3005

Phone

(401) 942-1450

Fax

(401) 946-1550

NPI assigned

Jun 6, 2023

Last updated

Jun 6, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Alisha Bourdeau

Title

Cfo

Phone

(401) 275-5038

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dee Anne Bates, MSN, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Middletown, RI
  • NPI 1912979774
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1447944111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 PARK AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029103225",
            "telephone_number": "401-275-5038",
            "fax_number": "401-942-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "349 HUNTINGTON AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029093005",
            "telephone_number": "401-942-1450",
            "fax_number": "401-946-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-06",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "BOURDEAU",
        "authorized_official_first_name": "ALISHA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "401-275-5038",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Cobb, RN
• Regina Cobb, MASSAGE THERAPIST
• Alexander Crone Coburn, MD, PHD
• Nancy J Cocchiarella, CRNP
• Nicholas Joseph Coccoluto, MD
• Codac Inc (Codac Providence)
• Codac Inc (CODAC North Main)
• Codac Inc (CODAC Behavioral Healthcare)
• Elizabeth Ann Coderre, LMHC
• Margaret Codispoti, R.N., CDOE

• Multi-Specialty Clinic/Center in Providence, RI
• Providers in Providence, RI by specialty
• Multi-Specialty Clinic/Center in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.