Provider Demographics
NPI:1023466984
Name:CARESTL HEALTH #4
Entity type:Organization
Organization Name:CARESTL HEALTH #4
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:R
Authorized Official - Last Name:ARCHIBALD-CLABON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:314-367-5820
Mailing Address - Street 1:4500 POPE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-2512
Mailing Address - Country:US
Mailing Address - Phone:314-385-3990
Mailing Address - Fax:314-389-2464
Practice Address - Street 1:4500 POPE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115
Practice Address - Country:US
Practice Address - Phone:314-385-3990
Practice Address - Fax:314-389-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336M0002X, 3336S0011X, 335E00000X
MO20160120673336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier