Barefootboy LLC
NPI #1790940989 in Springfield, Missouri
Provider Information
- NPI Number
- 1790940989
- Entity Type
- Organization
- Organization Name
- Barefootboy LLC
- Primary Specialty
- Residential Treatment Facility, Physical Disabilities
- Enumeration Date
- Jul 28, 2008
- Last Updated
- Jul 28, 2008
Practice Location
- Address
- 723 S SCENIC AVE
- Address 2
- 723 S.SCENIC
- City
- Springfield
- State
- Missouri
- ZIP Code
- 65802-5042
- Phone
- (417) 864-6200
Authorized Official
- Name
- MR. RAJAB TONGWA ECHESSA, ADMINISTRATOR
- Title
- ADMINISTRATOR
- Phone
- (417) 207-1680
Specialties & Taxonomy Codes
| Specialty |
|---|
| Residential Treatment Facility, Physical Disabilities |
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