Organization
CHERRY STREET SERVICES INC
Active
Parent organization
CHERRY STREET SERVICES, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHERRY STREET SERVICES, INC.
Authorized official
TASHA BLACKMON (CEO)
(616) 965-8200
Entity
Organization
Contact information
Practice address
421 FOUNTAIN ST NE, GRAND RAPIDS, MI 49503-3334
(616) 965-8200
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/08/2014
Last updated
06/25/2024
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