Healthcare Provider Details

I. General information

NPI: 1992950877
Provider Name (Legal Business Name): CANDLELIGHT IN- HOME COMPANION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MARQUETTE ST STE 1G
DAVENPORT IA
52806-4440
US

IV. Provider business mailing address

3901 MARQUETTE ST STE 1G
DAVENPORT IA
52806-4440
US

V. Phone/Fax

Practice location:
  • Phone: 563-391-8117
  • Fax: 563-391-0615
Mailing address:
  • Phone: 563-391-8117
  • Fax: 563-391-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CRYSTAL LYNN GUY
Title or Position: OWNER
Credential:
Phone: 563-391-8117