Provider Demographics
NPI:1972596088
Name:CARESTL HEALTH
Entity Type:Organization
Organization Name:CARESTL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLABON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-367-5820
Mailing Address - Street 1:PO BOX 772971
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0271
Mailing Address - Country:US
Mailing Address - Phone:314-898-1268
Mailing Address - Fax:855-298-7184
Practice Address - Street 1:5471 DR. MARTIN LUTHER KING
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-4265
Practice Address - Country:US
Practice Address - Phone:314-367-5820
Practice Address - Fax:314-367-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500622915Medicaid
MO000011200Medicare UPIN