Healthcare Provider Details

I. General information

NPI: 1467494062
Provider Name (Legal Business Name): CARESTL HEALTH #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 RIVERVIEW BLVD
SAINT LOUIS MO
63120
US

IV. Provider business mailing address

5541 RIVERVIEW BLVD
SAINT LOUIS MO
63120-2443
US

V. Phone/Fax

Practice location:
  • Phone: 314-389-4566
  • Fax: 314-382-0263
Mailing address:
  • Phone: 314-389-4566
  • Fax: 314-389-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number2005035950
License Number StateMO

VIII. Authorized Official

Name: MRS. ANGELA RENEE CLABON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 314-367-5820