Healthcare Provider Details

I. General information

NPI: 1720645013
Provider Name (Legal Business Name): CANDACE DILLWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 06/18/2025
Certification Date: 04/30/2025
Deactivation Date: 05/08/2025
Reactivation Date: 06/18/2025

III. Provider practice location address

150 W ATHENS RD
ROSEVILLE OH
43777-1028
US

IV. Provider business mailing address

150 W ATHENS RD
ROSEVILLE OH
43777-1028
US

V. Phone/Fax

Practice location:
  • Phone: 740-562-5287
  • Fax:
Mailing address:
  • Phone: 740-562-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: