Provider Demographics
NPI:1427268663
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:H
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-391-8117
Mailing Address - Street 1:PO BOX 1542
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52809-1542
Mailing Address - Country:US
Mailing Address - Phone:563-391-8117
Mailing Address - Fax:563-391-0615
Practice Address - Street 1:3901 N MARQUETTE ST
Practice Address - Street 2:SUITE 1D
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:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle