Codac North Main

LBN: Codac Inc
Codac North Main is an health care organization with primary practice located at 528 N Main St , Providence RI 02904-5757. The organization recently has 7 registered licenses in different health care specialties including Other Service Providers / Peer Specialist, Agencies / Public Health or Welfare, Ambulatory Health Care Facilities / Health Service, Ambulatory Health Care Facilities / Methadone, Ambulatory Health Care Facilities / Primary Care, Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder, Hospital Units / Rehabilitation, Substance Use Disorder Unit. Ambulatory Health Care Facilities / Methadone is the primary health care specialty. Codac Inc can be contacted via phone (401) 808-4278, or through Bourdeau, Alisha via phone (401) 275-5038.

Contact Information

Primary practice address
528 N Main St Providence RI 02904-5757
Phone: (401) 808-4278
Fax: (401) 808-6957
Website:
Map and Directions
Authorized official contact:
Name: Bourdeau, Alisha BS
Phone: (401) 275-5038

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X
Agencies / Public Health or Welfare 251K00000X 605.07 Rhode Island
Ambulatory Health Care Facilities / Health Service 261QH0100X 605.07 Rhode Island
Ambulatory Health Care Facilities / Methadone 261QM2800X 605.07 Rhode Island
Ambulatory Health Care Facilities / Primary Care 261QP2300X ACF01632 Rhode Island
Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder 261QR0405X 605.07 Rhode Island
Hospital Units / Rehabilitation, Substance Use Disorder Unit 276400000X 605.07 Rhode Island

Profile Details

NPI number 1558712034
LBN Legal business name Codac Inc
DBA Doing business as Codac North Main
Authorized official Bourdeau, Alisha BS
Entity Organization
Organization subpart 1 No
Enumeration date Jun 27th, 2016
Last updated Apr 25th, 2019 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558712034 NPPES
Rhode Island MEDICAID CI01382

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