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	261QD0000X	Dental Clinic/Center	520	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	:	1215140561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESTL HEALTH

Provider Business Mailing Address
First Line	:	5471 DR MARTIN LUTHER KING DR
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63112-4265
Country	:	US
Telephone Number	:	314-367-5820
Fax Number	:	314-367-7010

Provider Business Practice Location Address
First Line	:	4411 N NEWSTEAD AVE
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63115-2534
Country	:	US
Telephone Number	:	314-381-9990
Fax Number	:	314-381-8993

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	02/06/2019

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1023221744 — MR. WILLIAM GEORGE RANDLE JR. MSW, LCSW
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Practice Location Address:

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Directions to “CARESTL HEALTH ” Practice Location

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