Healthcare Provider Details

I. General information

NPI: 1609798289
Provider Name (Legal Business Name): KENNIETH ROSEAN JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25885 VILLAGE GREEN BLVD APT 106
HARRISON TOWNSHIP MI
48045-3057
US

IV. Provider business mailing address

46020 LAKE VILLA DR APT 103
BELLEVILLE MI
48111-3106
US

V. Phone/Fax

Practice location:
  • Phone: 248-820-2616
  • Fax:
Mailing address:
  • Phone: 248-820-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: