MEDICARE: CARESTL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649312570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESTL HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 772971
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0271
Country	:	US
Telephone Number	:	314-898-1268
Fax Number	:	855-298-7184

Provider Business Practice Location Address
First Line	:	5541 RIVERVIEW BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2443
Country	:	US
Telephone Number	:	314-389-4566
Fax Number	:	314-385-7859

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ANGELA R CLABON
Credential	:	MBA
Telephone Number	:	314-367-5820

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	06/27/2018

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Directions to “CARESTL HEALTH ” Practice Location

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