Individual ProviderCandyce JacksonCase Manager/Care CoordinatorOther Service ProvidersPractice Address1102 Commercial Dr, Hammond, LA 70403-5954(985) 662-3799PECOS EnrollmentBased on the most recent information from CMS, provider Candyce Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 7 days ago.Profile DetailsProvider ID1922651124Provider TypeIndividualFull NameJackson, CandyceGenderFemaleSole ProprietorYesEnumeration Date7/17/2019Last Updated7/17/2019Contact InformationPractice LocationPractice Address1102 Commercial Dr, Hammond, LA 70403-5954Phone(985) 662-3799FaxUnlisted FaxMailing LocationMailing Address1102 Commercial Dr, Hammond, LA 70403-5954Phone(985) 662-3799FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer