MEDICARE: BORN JONES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1396677035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORN JONES LLC

Provider Business Mailing Address
First Line	:	PO BOX 40081
Second Line	:
City	:	REDFORD
State	:	MI
Zip	:	48240-0081
Country	:	US
Telephone Number	:	313-785-5966
Fax Number	:

Provider Business Practice Location Address
First Line	:	23760 FENKELL ST APT 210A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1464
Country	:	US
Telephone Number	:	313-785-5966
Fax Number	:

Authorized Official
Title or Position	:	OPERATION MANAGER
Name	:	LATASHA WHITE
Credential	:
Telephone Number	:	313-785-5966

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “BORN JONES LLC ” Practice Location

Language	Start Address	Practice Location

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