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CODAC NORTH MAIN
NPI 1558712034
Clinic/Center - Methadone in Providence, RI

Active since June 27, 2016
528 N MAIN ST, PROVIDENCE, RI 02904(401) 808-4278(401) 808-6957 Get Directions Write a Review

NPPES record last updated: April 25, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 25, 2019, Mar 21, 2017, Jun 29, 2016 (3 updates tracked since 2016).

About Codac North Main NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CODAC NORTH MAIN (NPI 1558712034) is a healthcare organization registered as a methadone in Providence, Rhode Island and active in the NPI registry since June 2016. The organization lists Alisha Bourdeau, Cfo, as its authorized official.

NPPES Registry Identity

NPI1558712034
Entity TypeOrganization
Primary Taxonomy261QM2800X
Legal Business NameCODAC INC
Location Address528 N MAIN STProvidence, RI 02904-5757
Mailing Address1052 Park AveCranston, RI 02910-3225 · (401) 275-5039 · Fax (401) 942-3590
Phone(401) 808-4278
Fax(401) 808-6957
Organization SubpartNo
Authorized OfficialAlisha BourdeauCfo · (401) 275-5038
Enumeration DateJune 27, 2016
Last NPPES UpdateApril 25, 20193 updates tracked since enumeration
✔ NPI 1558712034 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

★ Primary SpecialtyClinic/Center · MethadoneAmbulatory Health Care Facilities
Taxonomy Code261QM2800X
License✔ Licensed in RI · 605.07
Definition
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.
Also ListedPeer SpecialistTaxonomy 175T00000X
Also ListedPublic Health or WelfareTaxonomy 251K00000X · License 605.07 (RI)
Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X · License 605.07 (RI)
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X · License ACF01632 (RI)
Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X · License 605.07 (RI)
Also ListedRehabilitation, Substance Use Disorder UnitTaxonomy 276400000X · License 605.07 (RI)
528 N MAIN ST, Providence, RI 02904
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Other Names 1

Doing Business AsCodac North Main

Other Identifiers 1

MedicaidCI01382RI

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAMES RICHARDSON
Counselor
528 N MAIN ST
PROVIDENCE, RI 02904
Providence County (140) 528-0123
MS. SARAH ANN SATTERLEE APRN
Nurse Practitioner (Psychiatric/Mental Health)
528 N MAIN ST
PROVIDENCE, RI 02904
Providence County (401) 276-4020
SHANNON MARGARET MCKEON RN
Registered Nurse
528 N MAIN ST
PROVIDENCE, RI 02904
Providence County (401) 528-0193
CYNTHIA BARRY LCSW
Social Worker
528 N MAIN ST
PROVIDENCE, RI 02904
Providence County (401) 528-0123
KAYLA LUCIA
Counselor (Mental Health)
528 N MAIN ST
PROVIDENCE, RI 02904
Providence County (401) 528-0123
LUANNE P CALVO LCSW
Social Worker
528 N MAIN ST
PROVIDENCE, RI 02904
Providence County (401) 528-0193
DR. STEVEN IRA COHEN M.D.
Surgery
528 N MAIN ST, SUITE 3
PROVIDENCE, RI 02904
Providence County (401) 421-3306
VANESSA MADRID BSN RN
Registered Nurse
528 N MAIN ST
PROVIDENCE, RI 02904
Providence County (401) 528-0123

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Codac Inc's NPI number?

The NPI number for Codac Inc is 1558712034. It was assigned to this organization in the NPPES registry on June 27, 2016. The provider is doing business as Codac North Main.

Where is Codac Inc located?

Codac Inc is located at 528 N Main St, Providence, RI 02904. The listed phone number is (401) 808-4278.

What is Codac Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Methadone, with taxonomy code 261QM2800X.

When was this NPI record last updated?

The NPPES record for Codac Inc was last updated on April 25, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.