Healthcare Provider Details

I. General information

NPI: 1972596088
Provider Name (Legal Business Name): CARESTL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 DR. MARTIN LUTHER KING
SAINT LOUIS MO
63112-4265
US

IV. Provider business mailing address

PO BOX 772971
CHICAGO IL
60677-0271
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-5820
  • Fax: 314-367-7010
Mailing address:
  • Phone: 314-898-1268
  • Fax: 855-298-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA R CLABON
Title or Position: CEO
Credential: MBA
Phone: 314-367-5820