Healthcare Provider Details

I. General information

NPI: 1154256741
Provider Name (Legal Business Name): SALIFOU ARMEL TIEMTORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 N 66TH ST
OMAHA NE
68104-1138
US

IV. Provider business mailing address

6430 N 66TH ST
OMAHA NE
68104-1138
US

V. Phone/Fax

Practice location:
  • Phone: 402-444-6500
  • Fax:
Mailing address:
  • Phone: 402-444-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: