Provider Demographics
NPI:1821370875
Name:LIMELIGHT GROUP
Entity type:Organization
Organization Name:LIMELIGHT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-927-5994
Mailing Address - Street 1:1730 SW HARBOR WAY
Mailing Address - Street 2:UNIT 507
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5100
Mailing Address - Country:US
Mailing Address - Phone:503-927-5994
Mailing Address - Fax:
Practice Address - Street 1:11782 SW BARNES RD
Practice Address - Street 2:BUILDING C SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5914
Practice Address - Country:US
Practice Address - Phone:503-906-4300
Practice Address - Fax:503-906-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO25617207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269726Medicaid