Provider Demographics
NPI:1457000184
Name:KABORE, HAOUA (HK)
Entity Type:Individual
Prefix:
First Name:HAOUA
Middle Name:
Last Name:KABORE
Suffix:
Gender:F
Credentials:HK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1252
Mailing Address - Country:US
Mailing Address - Phone:531-541-2840
Mailing Address - Fax:
Practice Address - Street 1:2633 N 165TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-7506
Practice Address - Country:US
Practice Address - Phone:531-541-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities