Individual
MS. LINDA K ROARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
219 W 24TH ST, SEDALIA, MO 65301-8303
(660) 826-0244
Mailing address
27880 HACKBERRY DR, SEDALIA, MO 65301-0561
(660) 826-0244
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
CC1-0207-0413
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
852752203
—
MO
Enumeration date
03/13/2014
Last updated
03/13/2014
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