Organization
CHERRY STREET SERVICES, INC.
Active
Other names
The Salvation Army Booth Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS SHEA (CEO)
(616) 776-2120
Entity
Organization
Contact information
Practice address
1215 FULTON ST E, GRAND RAPIDS, MI 49503-3849
(616) 459-9468
(616) 459-7223
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
(616) 940-5366
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
231857
FACILITY NUMBER
MI
Enumeration date
11/20/2006
Last updated
10/19/2012
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