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	261Q00000X	Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1609245448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESTL HEALTH

Provider Business Mailing Address
First Line	:	PO BOX
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0271
Country	:	US
Telephone Number	:	314-898-1268
Fax Number	:	855-298-7184

Provider Business Practice Location Address
First Line	:	4500 POPE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2512
Country	:	US
Telephone Number	:	314-367-5820
Fax Number	:	314-367-7010

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

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	06/27/2018

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Practice Location Address:

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Practice Location Address:

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Directions to “CARESTL HEALTH ” Practice Location

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