Provider Demographics
NPI:1992950877
Name:CANDLELIGHT IN- HOME COMPANION, INC
Entity type:Organization
Organization Name:CANDLELIGHT IN- HOME COMPANION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 STE 1G
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4440
Mailing Address - Country:US
Mailing Address - Phone:563-391-8117
Mailing Address - Fax:563-391-0615
Practice Address - Street 1:3901 MARQUETTE ST STE 1G
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4440
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:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000400375Medicaid