Healthcare Provider Details

I. General information

NPI: 1912653510
Provider Name (Legal Business Name): LOST CREEK CENTER FOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 S MUMAUGH RD
LIMA OH
45804-3569
US

IV. Provider business mailing address

50 CHESTNUT RIDGE RD STE 107
MONTVALE NJ
07645-1823
US

V. Phone/Fax

Practice location:
  • Phone: 419-225-9040
  • Fax:
Mailing address:
  • Phone: 908-327-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MORDECHAI WESIZ
Title or Position: CFO
Credential:
Phone: 347-631-4068