Candlelight Home Healthcare, LLC
Organization Active NPI Home Health Agency · Coal City, IL
NPI 1972914372 · NPPES record last updated Jun 23, 2022
Key facts
- NPI
- 1972914372
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- CANDLELIGHT HOME HEALTHCARE, LLC
- Practice address
- 115 S Broadway St
Coal City, IL 60416-1532 - Phone
- (815) 557-5948
- NPI assigned
- May 19, 2014
- Organization subpart
- No
Authorized official
- Name
- Mr. Timothy E Zelinko
- Title
- Ceo
- Phone
- (815) 557-5948
Affiliated clinicians 6
-
Spyro D Analytis, MD
-
Stefanie Henline, APN
-
Mark A Passerman, DO
-
Kathleen Ann Ulivi, FNP-BC
Medicare Care Compare: Home health agency
- Listed as
- Candlelight Home Healthcare LLC
- Overall star rating
- ★★★★☆ 4 of 5
- Ownership
- Proprietary
- Certified
- May 25, 2016
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2097720 | Candlelight Home Healthcare LLC | Certificate of waiver | Jun 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Home health agency certification: CCN 148375
- Legal name
- CANDLELIGHT HOME HEALTHCARE, LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 25, 2016
- Last certification
- May 25, 2016
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 24, 2014 in IL
- Enrollment address
- 115 S Broadway St
Coal City, IL 60416-1532
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Ayowale B Alao |
5% Or Greater Direct Ownership Interest |
Jul 7, 2014 | 27.5% |
| Diane Fortin |
W-2 Managing Employee |
Jul 17, 2014 | |
| Omolara Alao |
5% Or Greater Direct Ownership Interest |
Jul 7, 2014 | 27.5% |
| Timothy Zelinko |
5% Or Greater Direct Ownership Interest |
Jul 7, 2014 | 45% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151014003425 | IL | Part a Provider - Home Health Agency | 4688983554 | Practice locations: Coal City, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
115 S Broadway St
Coal City, IL 60416-1532
Mailing address
115 S Broadway St
Coal City, IL 60416-1532
Phone (815) 557-5948
Other providers in Coal City, IL
- Authentic Counseling and Therapy, PLLC
- Thomas E Beverly
- Sherri Blair
- Boltron Dialysis LLC
- Broadway Family Dental Center
- Kinga Cano
- Kristina Caponi
- Caricare Mobile Medical LLC
- Jennifer Wai-Ling Chu
- Coal City Cu School Dist 1
All providers in Coal City, IL · Home Health Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.