Healthcare Provider Details

I. General information

NPI: 1124966759
Provider Name (Legal Business Name): MEADOW FALLS WICKLIFFE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30630 RIDGE RD
WICKLIFFE OH
44092-1166
US

IV. Provider business mailing address

30630 RIDGE RD
WICKLIFFE OH
44092-1166
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-2050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AVI LUSTIG
Title or Position: MANAGER
Credential:
Phone: 917-544-4713