NPIMap

Organization Active NPI

Codac Inc

Doing business as CODAC Behavioral Healthcare

  • Methadone Clinic
  • Providence, RI
National Provider Identifier
1992530109
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
CODAC INC
Doing business as
CODAC Behavioral Healthcare
Practice address
45 Royal Little Dr
Providence, RI 02904-1882
Phone
(401) 275-5038
Fax
(401) 942-3590
NPI assigned
Sep 6, 2024
Last updated
Sep 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Ms. Alisha M Bourdeau
Title
Chief Financial Officer
Phone
(401) 275-5038

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X NU
Methadone Clinic 261QM2800X NU Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU

Addresses

Primary practice location

45 Royal Little Dr
Providence, RI 02904-1882

Mailing address

1052 Park Ave
Cranston, RI 02910-3225
Phone (401) 275-5038

Other names 1

  • CODAC Behavioral Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Opioid treatment program
Medicare-enrolled since Mar 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Codac Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

850 Waterman Ave
East Providence, RI 02914
Phone (401) 434-0459

93 Thames St
Newport, RI 02840
Phone (401) 346-4932

600 Pawtucket Ave
Pawtucket, RI 02860
Phone (401) 728-2200

45 Royal Little Dr
Providence, RI 02904
Phone (401) 275-5038

3045 Tower Hill Rd
Unit 3
Saunderstown, RI 02874
Phone (401) 789-0934

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1992530109",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 ROYAL LITTLE DR",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029041882",
            "telephone_number": "401-275-5038",
            "fax_number": "401-942-3590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "BOURDEAU",
        "authorized_official_first_name": "ALISHA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "401-275-5038",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CODAC Behavioral Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.