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General NPI Number Information
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NPI Number | 1659176592
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Entity Type | Organization
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Legal Business Name | LONMAFFO SUPPORTED LIVING LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 11714 HARDEN CT
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City | CINCINNATI
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State | OH
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Zip | 45240-1923
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Country | US
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Telephone | 513-374-9049
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Fax |
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Provider Business Mailing Address
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Address Line | 230 NORTHLAND BLVD STE 117
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City | SPRINGDALE
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State | OH
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Zip | 45246-0009
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Country | US
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Telephone | 513-374-9049
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. BERNARD TCHUENKOU NGONGANG
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Credential | DO
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Telephone | 513-374-9049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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