Provider Demographics
NPI:1437790219
Name:ROARK, DARIN
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:ROARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 SE KIMBROUGH LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1082
Mailing Address - Country:US
Mailing Address - Phone:816-582-3508
Mailing Address - Fax:
Practice Address - Street 1:2628 SE KIMBROUGH LN
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1082
Practice Address - Country:US
Practice Address - Phone:816-582-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities