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Organization
BAREFOOTBOY LLC
Active
Organization
BAREFOOTBOY LLC
Active
Other names
OAKBROOK RESIDENCE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAJAB TONGWA ECHESSA ADMINISTRATOR (ADMINISTRATOR)
(417) 207-1680
Entity
Organization
Contact information
Practice address
723 S SCENIC AVE, 723 S.SCENIC, SPRINGFIELD, MO 65802-5042
(417) 864-6200
(417) 864-4413
Mailing address
723 S SCENIC AVE, 723 S.SCENIC, SPRINGFIELD, MO 65802-5042
(417) 864-6200
(417) 864-4413
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
035394
MO
Other
Enumeration date
07/28/2008
Last updated
07/28/2008
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