Organization
CHERRY STREET SERVICES INC
Active
Parent organization
CHERRY STREET SERVICES INC
Other names
Cherry Health - Southside Health Center Suite 200
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
2303 KALAMAZOO AVE SE STE 200, GRAND RAPIDS, MI 49507-3780
(616) 965-8379
(616) 940-5354
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8209
(616) 940-5366
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
207L00000X
Anesthesiology Physician
—
—
207LA0401X
Addiction Medicine (Anesthesiology) Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/26/2021
Last updated
08/31/2021
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