Healthcare Provider Details

I. General information

NPI: 1841921459
Provider Name (Legal Business Name): LIMELIGHT ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 S GLENCOE WAY
CENTENNIAL CO
80121-3427
US

IV. Provider business mailing address

4751 TRAILS EDGE LN
CASTLE ROCK CO
80104-7319
US

V. Phone/Fax

Practice location:
  • Phone: 814-722-1559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MOTOLANI OWOLABI
Title or Position: ADMIN
Credential:
Phone: 814-722-1559