| Cherry Street Services Inc | |
|
421 Fountain St Ne Grand Rapids MI 49503-3334 | |
| (616) 965-8200 | |
| Not Available |
| Full Name | Cherry Street Services Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 421 Fountain St Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Tasha Blackmon (CEO) |
| Authorized Official Contact | 6169658200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cherry Street Services Inc 100 Cherry St Se Grand Rapids MI 49503-4526 Ph: (616) 965-8200 | Cherry Street Services Inc 421 Fountain St Ne Grand Rapids MI 49503-3334 Ph: (616) 965-8200 |
| NPI Number | 1316340094 |
|---|---|
| Provider Enumeration Date | 10/08/2014 |
| Last Update Date | 06/25/2024 |
| Certification Date | 06/25/2024 |
| Medicare PECOS PAC ID | 6800707647 |
|---|---|
| Medicare Enrollment ID | O20161117000608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316340094 | NPI | - | NPPES |
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