Healthcare Provider Details

I. General information

NPI: 1740206697
Provider Name (Legal Business Name): CARESTL HEALTH #3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 WHITTIER ST
SAINT LOUIS MO
63113-2950
US

IV. Provider business mailing address

2425 WHITTIER ST
SAINT LOUIS MO
63113-2950
US

V. Phone/Fax

Practice location:
  • Phone: 314-371-3100
  • Fax: 314-535-4662
Mailing address:
  • Phone: 314-371-3100
  • Fax: 314-535-4662

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 Number2005035951
License Number StateMO

VIII. Authorized Official

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