BAREFOOTBOY LLC (NPI# 1790940989) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790940989 |
| Entity Type | Organization |
| Organization Name | BAREFOOTBOY LLC |
| Other Organization Name | OAKBROOK RESIDENCE |
| Practice Address |
723 S Scenic Ave 723 S.scenic Springfield MO 65802-5042 |
| Practice Telephone | 4178646200 |
| Practice Fax Number | 4178644413 |
| Mailing Telephone | 4178646200 |
| Mailing Fax Number | 4178644413 |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2008-07-28 |
| Authorized Official Name | MR. RAJAB TONGWA ECHESSA (ADMINISTRATOR) |
| Authorized Official Telephone | 4172071680 |
| Authorized Official Credential | ADMINISTRATOR |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | 035394 | MO | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 266758408 | 05 |
| Other Name | Type Code |
|---|---|
| OAKBROOK RESIDENCE | Doing Business As Name - Organization |
| Street Address |
723 S SCENIC AVE 723 S.SCENIC |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65802-5042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454549 | Andrea Strauch | Counselor | 2024 W Chestnut Expressway Way, Springfield, MO 65802 | 2020-10-12 |
| 1962968867 | Chad Michael Linck | Specialist/Technologist | 2125 N Glenstone Ave, Springfield, MO 65802 | 2019-02-15 |
| 1790254647 | Meds To Live By | Pharmacist | 1134 N. Scarlett Way, Springfield, MO 65802 | 2018-11-21 |
| 1568945103 | Ficom | Non-Pharmacy Dispensing Site | 1308 North Glenstone Avenue, Springfield, MO 65802 | 2018-09-10 |
| 1982194775 | Karla Caballero | Marriage & Family Therapist | 8627 Montant Fort Way, 145, Sprinfield, MO 65802 | 2018-05-16 |
| 1780191809 | Tiffany Chawntay Coryell | Pharmacist | 1134 North Scarlett Way, Springfield, MO 65802 | 2018-01-10 |
| 1083134902 | Trevor Conner | Family Medicine | 1423 N Jefferson Ave, B100, Springfield, MO 65802 | 2017-06-21 |
| 1407389596 | Medical Mile Imaging | Radiology | 3905 E Windsmore Dr, Springfield, MO 65802 | 2017-04-06 |
| 1346619103 | Jill A Knight | Occupational Therapist | 1601 E. Pythian, Green Valley State School, Springfield, MO 65802 | 2015-09-22 |
| 1447653258 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 3720 E Sunshine St, Springfield, MO 65802 | 2014-10-07 |
| Find all providers in zip 65802 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225588494 | Afia Ayiwa-mensah | Residential Treatment Facility, Physical Disabilities | 58 Savoy Ave, Springfield, MA 01104-2008 | 2016-10-11 |
| 1477945194 | Mary Weller | Residential Treatment Facility, Physical Disabilities | 3331 Wendover St, Springfield, OH 45506-4315 | 2015-03-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518367614 | Healn Heart Home Healthcare Inc | Residential Treatment Facility, Physical Disabilities | 2047 S Swope Dr, Apt C, Independence, MO 64057-1003 | 2014-08-26 |
| 1891103404 | Karing Homes LLC | Residential Treatment Facility, Physical Disabilities | 6139 Forest Ave, Kansas City, MO 64110-3427 | 2014-07-28 |
| 1275877805 | Ride On St Louis, Inc. | Residential Treatment Facility, Physical Disabilities | 6008 Windsor Harbor Ln, Imperial, MO 63052 | 2012-11-20 |
| 1558659466 | Heritage Hills LLC | Residential Treatment Facility, Physical Disabilities | Po Box B, Patton, MO 63662-0010 | 2011-07-12 |
| 1922335926 | Blue Hayven In-home Health Care | Residential Treatment Facility, Physical Disabilities | 11553 Withersfield Dr, Saint Louis, MO 63138-1152 | 2009-11-11 |
| 1285787002 | Bliss Manor, Inc. | Residential Treatment Facility, Physical Disabilities | 2929 Lafayette St, Saint Joseph, MO 64507-1615 | 2007-01-18 |
| 1326119553 | Hickory Hills Residential Care | Residential Treatment Facility, Physical Disabilities | 935 Spartan Ln, Foristell, MO 63348-1022 | 2006-11-10 |
| 1568541886 | Shalimar Corp | Residential Treatment Facility, Physical Disabilities | 2732 Bloomfield Rd, Cape Girardeau, MO 63703-6302 | 2006-11-06 |
| 1437130747 | Flo-gp Leasing Co., LLC | Residential Treatment Facility, Physical Disabilities | 250 S New Florissant Rd, Florissant, MO 63031-6716 | 2005-11-14 |
| 1508311747 | N & R of Maryville LLC | Residential Treatment Facility, Physical Disabilities | 524 N Laura St, Maryville, MO 64468-1955 | 2016-08-17 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGFIELD |
| Zip Code | 65802 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.