CHERRY STREET SERVICES INC NPI 1386926004

NPI Information

NPI: 1386926004
Provider Name: CHERRY STREET SERVICES INC

Doing Business As: SOUTHSIDE HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 23D2036900

Address:
2303 KALAMAZOO AVE SE
GRAND RAPIDS, MI
ZIP 49507
Phone: (616) 965-8390
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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 1386926004. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Southside Health Center.

The provider's business location address is:

2303 KALAMAZOO AVE SE
GRAND RAPIDS, MI
ZIP 49507-780
Phone: (616) 965-8390
Fax: (616) 254-8192

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 23D2036900 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/20/2011 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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	No
2	101YM0800X	Counselor	Mental Health	No
3	103TA0400X	Psychologist	Addiction (Substance Use Disorder)	No
4	103TC0700X	Psychologist	Clinical	No
5	1041C0700X	Social Worker	Clinical	No
6	163W00000X	Registered Nurse		No
7	207LA0401X	Anesthesiology	Addiction Medicine	No
8	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: 4/28/2024

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