Provider Demographics
NPI:1972887008
Name:MCCANDLESS, JENNIFER LEE (HOME HEALTH CARE)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:MCCANDLESS
Suffix:
Gender:F
Credentials:HOME HEALTH CARE
Other - Prefix:
Other - First Name:THE
Other - Middle Name:COUNTRY
Other - Last Name:HOMESTEADS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOME HEALTH CARE PRO
Mailing Address - Street 1:511 HEADQUARTERS RD
Mailing Address - Street 2:
Mailing Address - City:ERWINNA
Mailing Address - State:PA
Mailing Address - Zip Code:18920-9245
Mailing Address - Country:US
Mailing Address - Phone:610-847-1268
Mailing Address - Fax:610-847-2200
Practice Address - Street 1:511 HEADQUARTERS RD
Practice Address - Street 2:
Practice Address - City:ERWINNA
Practice Address - State:PA
Practice Address - Zip Code:18920-9245
Practice Address - Country:US
Practice Address - Phone:610-847-1268
Practice Address - Fax:610-847-2200
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13023601172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker