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Organization

CARESTL HEALTH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ANGELA RENEE CLABON MBA (CHIEF EXECUTIVE OFFICER)
(314) 367-5820
Entity
Organization

Contact information

Practice address
5471 DR MARTIN LUTHER KING DR, ST LOUIS, MO 63112
(314) 367-5820
(314) 367-7010
Mailing address
5471 DR MARTIN LUTHER KING DR, ST LOUIS, MO 63112-4265
(314) 367-5820
(314) 367-7010

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
519
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
26DO438768
CLIA
MO
05
700622913
MO
Enumeration date
05/07/2007
Last updated
06/07/2018
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