CHERRY STREET SERVICES INC NPI 1316340094

NPI Information

NPI: 1316340094
Provider Name: CHERRY STREET SERVICES INC
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 23D0380125

Address:
421 FOUNTAIN ST NE
GRAND RAPIDS, MI
ZIP 49503
Phone: (616) 965-8200
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CHERRY STREET SERVICES INC is a federally qualified health center (fqhc) clinic center in Grand Rapids, MI. CHERRY STREET SERVICES INC NPI is 1316340094. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

421 FOUNTAIN ST NE
GRAND RAPIDS, MI
ZIP 49503-334
Phone: (616) 965-8200

The provider's authorized official is Tasha Blackmon .
The authorized official title is Ceo and has the following contact phone number (616) 965-8200.

The CLIA number assigned to this NPI record is 23D0380125 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/8/2014 and was last updated on 4/4/2018.

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	Taxonomy Specialization	Primary
1	1041C0700X	Social Worker	Clinical	No
2	207Q00000X	Family Medicine		No
3	261QD0000X	Clinic/Center	Dental	No
4	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	Yes

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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