Provider Demographics
NPI:1720645013
Name:DILLWORTH, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:DILLWORTH
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 1:150 W ATHENS RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43777-1028
Mailing Address - Country:US
Mailing Address - Phone:740-562-5287
Mailing Address - Fax:
Practice Address - Street 1:150 W ATHENS RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43777-1028
Practice Address - Country:US
Practice Address - Phone:740-562-5287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2025-06-18
Deactivation Date:2025-05-08
Deactivation Code:
Reactivation Date:2025-06-18
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator