Provider Demographics
NPI:1821326273
Name:CINCINNATI HEALING ARTS LLC
Entity Type:Organization
Organization Name:CINCINNATI HEALING ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. MADDOX
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:KIANGA
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-252-8043
Mailing Address - Street 1:215 CLINTON SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217-1905
Mailing Address - Country:US
Mailing Address - Phone:513-252-8043
Mailing Address - Fax:
Practice Address - Street 1:215 CLINTON SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-1905
Practice Address - Country:US
Practice Address - Phone:513-252-8043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3869302R00000X
KY5095302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization