Organization
CHERRY STREET SERVICES, INC.
Active
Other names
Westside Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
TASHA BLACKMON (CEO)
(616) 965-8200
Entity
Organization
Contact information
Practice address
669 STOCKING AVE NW, GRAND RAPIDS, MI 49504-5176
(616) 235-1480
(616) 458-8102
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
(616) 940-5366
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
104100000X
Social Worker
—
MI
122300000X
Dentist
—
—
133N00000X
Nutritionist
—
MI
163W00000X
Registered Nurse
—
MI
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
11/15/2006
Last updated
05/07/2018
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