CHERRY STREET SERVICES INC. NPI 1841449105

NPI Information

NPI: 1841449105
Provider Name: CHERRY STREET SERVICES, INC.

Other Name: FERGUSON DENTAL

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

Specialization: Federally Qualified Health Center (FQHC)

Address:
101 SHELDON BLVD SE STE 1
GRAND RAPIDS, MI
ZIP 49503
Phone: (616) 776-2340
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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 1841449105. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Ferguson Dental.

The provider's business location address is:

101 SHELDON BLVD SE STE 1
GRAND RAPIDS, MI
ZIP 49503-950
Phone: (616) 776-2340
Fax: (616) 776-2341

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

The CLIA number assigned to this NPI record is 23D2175772 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/11/2008 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	License Number	License State	Primary
1	122300000X	Dentist				No
2	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: 5/5/2024

NPI Synchronization or Removal

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