Provider Demographics
NPI:1932240561
Name:FRANKLIN COUNTY SB40 RESOURCE BOARD
Entity type:Organization
Organization Name:FRANKLIN COUNTY SB40 RESOURCE BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-583-5801
Mailing Address - Street 1:104 S MCKINLEY AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1800
Mailing Address - Country:US
Mailing Address - Phone:636-584-7240
Mailing Address - Fax:888-280-1058
Practice Address - Street 1:104 S MCKINLEY AVE
Practice Address - Street 2:SUITE E
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1800
Practice Address - Country:US
Practice Address - Phone:636-584-7240
Practice Address - Fax:888-280-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO156249203Medicaid