Provider Demographics
NPI:1629675426
Name:ADAMS, CANDACE G
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:G
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-9784
Mailing Address - Country:US
Mailing Address - Phone:419-230-5082
Mailing Address - Fax:
Practice Address - Street 1:4414 PIONEER RD
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-9784
Practice Address - Country:US
Practice Address - Phone:419-230-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3110949Medicaid