Provider Demographics
NPI:1508014408
Name:CANDLELIGHT SERVICES LLC
Entity Type:Organization
Organization Name:CANDLELIGHT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-579-7293
Mailing Address - Street 1:3901 MARQUETTE ST
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4445
Mailing Address - Country:US
Mailing Address - Phone:563-391-8117
Mailing Address - Fax:
Practice Address - Street 1:3901 N MARQUETTE
Practice Address - Street 2:SUITE 1G
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4445
Practice Address - Country:US
Practice Address - Phone:563-391-8117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)