Codac Inc
Organization Active NPI Methadone Clinic · Saunderstown, RI
NPI 1679799217 · NPPES record last updated Dec 21, 2021
Key facts
- NPI
- 1679799217
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- License
- 605.06 (RI)
- Legal business name
- CODAC INC
- Practice address
- 3045 Tower Hill Rd
Saunderstown, RI 02874-1501 - Phone
- (401) 789-0934
- Fax
- (401) 789-0251
- NPI assigned
- Apr 18, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Alisha M Bourdeau, BS
- Title
- Cfo
- Phone
- (401) 275-5038
Other NPIs on the same Medicare enrollment 7
Corporate family (same tax ID) 9
Practitioners 3
-
Kim Marie Gonzaga, LCDP
-
Heather Anne Osterberg-Aloi, DOCTORATE/LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Opioid treatment program
- Medicare-enrolled since Mar 1, 2020
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200618002698 | RI | Part B Supplier - Opioid Treatment Program (Otp) | 4183046212 |
7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Warwick, RI; Saunderstown, RI; Providence, RI; Newport, RI; Cranston, RI; East Providence, RI |
National Provider Directory
- Tax ID family
- Codac Inc
Locations
3045 Tower Hill Rd
Saunderstown, RI 02874
Phone (401) 782-5500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist |
175T00000X | |||
| Addiction Medicine (Family Medicine) Physician |
207QA0401X | ACF01632-02 | RI | |
| Public Health or Welfare Agency | 251K00000X | 605.6 | RI | |
| Methadone Clinic | 261QM2800X | 605.6 | RI | |
| Methadone Clinic | 261QM2800X | 605.06 | RI | Yes |
| Primary Care Clinic/Center | 261QP2300X | ACF01632-02 | RI | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 605.6 | RI | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 605.06 | RI | |
| Substance Use Disorder Rehabilitation Hospital Unit | 276400000X | 605.6 | RI |
Addresses
Primary practice location
3045 Tower Hill Rd
Saunderstown, RI 02874-1501
Mailing address
1052 Park Ave
Cranston, RI 02910
Phone (401) 275-5038
Other names
- Codac South County
Other providers in Saunderstown, RI
- Amy Beth Ciarniello
- Sarah Clarke
- Catherine Conrad
- Ann Marie Marie Glanville
- Michelle Anne Hall
- Lauren Howard
- Danielle Hubbard
All providers in Saunderstown, RI · Methadone Clinic in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.