Provider Demographics
NPI:1801197744
Name:CARESTL HEALTH
Entity Type:Organization
Organization Name:CARESTL HEALTH
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 1:2425 WHITTIER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-2950
Mailing Address - Country:US
Mailing Address - Phone:314-371-3100
Mailing Address - Fax:314-535-4662
Practice Address - Street 1:2425 WHITTIER ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113
Practice Address - Country:US
Practice Address - Phone:314-371-3100
Practice Address - Fax:314-535-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO20050359513336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2639411OtherNCPDP PROVIDER IDENTIFICATION NUMBER