Provider Demographics
NPI:1083359954
Name:HENCE, KAHDIMA
Entity Type:Individual
Prefix:MRS
First Name:KAHDIMA
Middle Name:
Last Name:HENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18482 PIERSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2562
Mailing Address - Country:US
Mailing Address - Phone:734-829-8940
Mailing Address - Fax:
Practice Address - Street 1:18482 PIERSON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2562
Practice Address - Country:US
Practice Address - Phone:734-829-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X, 253Z00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF640461488567OtherIDENIFICATION CARD