Healthcare Provider Details

I. General information

NPI: 1447181425
Provider Name (Legal Business Name): BROTHAS INC. YOUTH INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 PADDOCK RD
CINCINNATI OH
45237-5509
US

IV. Provider business mailing address

4245 REDWOOD TER
CINCINNATI OH
45217-1825
US

V. Phone/Fax

Practice location:
  • Phone: 937-856-6523
  • Fax:
Mailing address:
  • Phone: 937-856-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: RONNELL ELLISON SR.
Title or Position: PRESIDENT
Credential:
Phone: 937-856-6523