Provider Demographics
NPI:1265927172
Name:OLEITA, KESENA JONES (OWNER)
Entity type:Individual
Prefix:
First Name:KESENA
Middle Name:JONES
Last Name:OLEITA
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23111 LEIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2772
Mailing Address - Country:US
Mailing Address - Phone:832-387-8068
Mailing Address - Fax:734-307-7719
Practice Address - Street 1:23111 LEIGHWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2772
Practice Address - Country:US
Practice Address - Phone:832-387-8068
Practice Address - Fax:734-307-7719
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 177F00000X, 251E00000X
MI5803000821343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No177F00000XOther Service ProvidersLodging
No251E00000XAgenciesHome Health