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General NPI Number Information
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NPI Number | 1306059654
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Entity Type | Organization
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Legal Business Name | CARESTL HEALTH
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 5471 DR MARTIN LUTHER KING DR
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City | ST LOUIS
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State | MO
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Zip | 63112
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Country | US
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Telephone | 314-367-5820
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Fax | 314-367-7010
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Provider Business Mailing Address
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Address Line | 5471 DR MARTIN LUTHER KING DR
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City | ST LOUIS
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State | MO
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Zip | 63112-4265
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Country | US
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Telephone | 314-367-5820
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Fax | 314-367-7010
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. ANGELA RENEE CLABON
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Credential | MBA
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Telephone | 314-367-5820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 519
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License Number State | MO
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