# BAREFOOTBOY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OAKBROOK RESIDENCE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790940989
- **Authorized official:** MR. RAJAB TONGWA ECHESSA ADMINISTRATOR (ADMINISTRATOR)
- **Authorized official phone:** (417) 207-1680

## Contact information

- **Practice address:** 723 S SCENIC AVE, 723 S.SCENIC, SPRINGFIELD, MO 65802-5042
- **Practice address phone:** (417) 864-6200
- **Practice address fax:** (417) 864-4413
- **Mailing address:** 723 S SCENIC AVE, 723 S.SCENIC, SPRINGFIELD, MO 65802-5042
- **Mailing address phone:** (417) 864-6200
- **Mailing address fax:** (417) 864-4413

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 035394 | MO | Yes |

## Other

- **Enumeration date:** 07/28/2008
- **Last updated:** 07/28/2008