Provider Demographics
NPI:1659176592
Name:LONMAFFO SUPPORTED LIVING LLC
Entity type:Organization
Organization Name:LONMAFFO SUPPORTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:TCHUENKOU
Authorized Official - Last Name:NGONGANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-374-9049
Mailing Address - Street 1:230 NORTHLAND BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-0009
Mailing Address - Country:US
Mailing Address - Phone:513-374-9049
Mailing Address - Fax:
Practice Address - Street 1:11714 HARDEN CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1923
Practice Address - Country:US
Practice Address - Phone:513-374-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health