CHERRY STREET SERVICES INC NPI 1386926004

NPI Details

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 of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

• Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm (HCPCS:G2067)
• Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure (HCPCS:G2078)
• Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for (HCPCS:G2077)
• Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) (HCPCS:G2074)

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: