MEDICARE: LIMELIGHT ASSISTED LIVING - PUEBLO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3104A0625X	Assisted Living Facility (Mental Illness)
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
3	310500000X	Mental Illness Intermediate Care Facility
4	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1982542171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMELIGHT ASSISTED LIVING - PUEBLO LLC

Provider Business Mailing Address
First Line	:	7193 S WATERLOO WAY
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80016-7642
Country	:	US
Telephone Number	:	814-722-1559
Fax Number	:	303-205-0073

Provider Business Practice Location Address
First Line	:	1145 BROCKDELL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-3547
Country	:	US
Telephone Number	:	814-722-1559
Fax Number	:	303-205-0073

Authorized Official
Title or Position	:	ADMIN
Name	:	MOTOLANI OWOLABI
Credential	:
Telephone Number	:	814-722-1559

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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