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	523	MO

General Provider Information

NPI Number	:	1578776829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESTL HEALTH

Provider Business Mailing Address
First Line	:	5471 DR MARTIN LUTHER KING DRIVE
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	:	2425 WHITTIER
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63113-2950
Country	:	US
Telephone Number	:	314-367-5820
Fax Number	:

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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Directions to “CARESTL HEALTH ” Practice Location

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