Organization
CHERRY STREET SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TASHA BLACKMON (CEO)
(616) 776-2128
Entity
Organization
Contact information
Practice address
100 CHERRY STREET, GRAND RAPIDS, MI 49503
(616) 965-8200
Mailing address
100 CHERRY STREET SE, GRAND RAPIDS, MI 49503
(616) 965-8200
(616) 940-5366
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
152W00000X
Optometrist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
04/25/2014
Last updated
10/10/2023
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