CHERRY STREET SERVICES INC. NPI 1124187471

NPI Information

CHERRY STREET SERVICES, INC. is a federally qualified health center (fqhc) clinic center in Grand Rapids, MI. CHERRY STREET SERVICES, INC. NPI is 1124187471. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Ottawa Hills High School Health Center.

The provider's business location address is:

2055 ROSEWOOD AVE SE
GRAND RAPIDS, MI
ZIP 49506-248
Phone: (616) 776-5110
Fax: (616) 776-5111

The provider's authorized official is Tasha Blackmon .
The authorized official title is Ceo and has the following contact phone number (616) 965-8215.

The CLIA number assigned to this NPI record is 23D1045434 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/6/2006 and was last updated on 8/25/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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