CHERRY STREET SERVICES INC. NPI 1063586816

NPI Information

NPI: 1063586816
Provider Name: CHERRY STREET SERVICES, INC.

Doing Business As: THE SALVATION ARMY BOOTH CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
1215 FULTON ST E
GRAND RAPIDS, MI
ZIP 49503
Phone: (616) 459-9468
Get Directions

CHERRY STREET SERVICES, INC. is a family medicine in Grand Rapids, MI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CHERRY STREET SERVICES, INC. NPI is 1063586816. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As The Salvation Army Booth Clinic.

The provider's business location address is:

1215 FULTON ST E
GRAND RAPIDS, MI
ZIP 49503-849
Phone: (616) 459-9468
Fax: (616) 459-7223

The provider's authorized official is Chris Shea .
The authorized official title is Ceo and has the following contact phone number (616) 776-2120.

The enumeration date for this NPI number is 11/20/2006 and was last updated on 10/19/2012.

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:

No.	Taxonomy Code	Taxonomy Clasification	Primary
1	104100000X	Social Worker	No
2	122300000X	Dentist	No
3	207Q00000X	Family Medicine	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	231857	MEDICARE OSCAR/CERTIFICATION	MICHIGAN
2	231857	OTHER	MICHIGAN	FACILITY NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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