Provider Demographics
NPI:1619455847
Name:CANDELLA
Entity Type:Organization
Organization Name:CANDELLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY FINCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:712-268-5503
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-0225
Mailing Address - Country:US
Mailing Address - Phone:712-268-5503
Mailing Address - Fax:
Practice Address - Street 1:427 E KANESVILLE BLVD STE 411
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4403
Practice Address - Country:US
Practice Address - Phone:712-268-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0071231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty