Provider Demographics
NPI:1932481561
Name:CANDLELIGHT IN-HOME CARE INC
Entity Type:Organization
Organization Name:CANDLELIGHT IN-HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-391-8117
Mailing Address - Street 1:3901 MARQUETTE ST
Mailing Address - Street 2:SUITE# 1-G
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:563-391-0615
Practice Address - Street 1:3901 MARQUETTE ST
Practice Address - Street 2:SUITE# 1-G
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:563-391-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)