| NPI | 1215153945 |
|---|---|
| Doing Business As | CODAC PROVIDENCE |
| Entity Type | Organization |
| Authorized Contact | ALISHA M BOURDEAU CFO 401-275-5038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: RI 605.05) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: RI ACF01632) | |
| 251K00000X Public Health or Welfare (Licence: RI 605.5) | |
| 261QM2800X Clinic/Center, Methadone Clinic (Licence: RI 605.5) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: RI ACF01632) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: RI 605.5) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: RI 605.05) | |
| 276400000X Rehabilitation, Substance Use Disorder Unit (Licence: RI 605.5) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-12-21 |