NPI 1790940989

Barefootboy LLC

Organisation Physical Disabilities Residential Treatment Facility Springfield, MO

Practice location

Address: 723 S Scenic Ave 723 S.Scenic, Springfield, MO 65802-5042
Phone: (417) 864-6200
Fax: (417) 864-4413

Authorised official

Name: Rajab Tongwa Echessa
Title: Administrator
Phone: (417) 207-1680

Registered specialties

Physical Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320700000X Licence 035394 (MO)

Other Residential Treatment Facility, Physical Disabilities providers in Missouri →

Registry record

NPI: 1790940989
Entity type: Organization
NPI issued: 28 Jul 2008
Record last updated: 28 Jul 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.