| NPI | 1629632609 |
|---|---|
| Doing Business As | CODAC PAWTUCKET AVE |
| Entity Type | Organization |
| Authorized Contact | ALISHA M BOURDEAU CFO 401-275-5038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 251K00000X Public Health or Welfare | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QR0400X Clinic/Center, Rehabilitation | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2021-12-21 |