Provider Demographics
NPI:1467494062
Name:CARESTL HEALTH #2
Entity Type:Organization
Organization Name:CARESTL HEALTH #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CLABON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-367-5820
Mailing Address - Street 1:5541 RIVERVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-2443
Mailing Address - Country:US
Mailing Address - Phone:314-389-4566
Mailing Address - Fax:314-389-5514
Practice Address - Street 1:5541 RIVERVIEW BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120
Practice Address - Country:US
Practice Address - Phone:314-389-4566
Practice Address - Fax:314-382-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336M0002X, 335E00000X
MO20050359503336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
2049138OtherPK