NPIMap

Organization Active NPI

Cherry Street Services Inc

Doing business as Heart of the City Health Center West

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1013292580
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CHERRY STREET SERVICES INC
Doing business as
Heart of the City Health Center West
Practice address
201 Sheldon Blvd SE
Grand Rapids, MI 49503-4513
Phone
(616) 965-8282
Fax
(616) 940-5366
NPI assigned
Oct 17, 2011
Last updated
Dec 29, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CHERRY STREET SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tasha Blackmon
Title
Chief Executive Officer
Phone
(616) 965-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

201 Sheldon Blvd SE
Grand Rapids, MI 49503-4513

Mailing address

100 Cherry St SE
Grand Rapids, MI 49503-4526
Phone (616) 965-8200

Other names 1

  • Heart of the City Health Center West Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013292580. Details of each certification follow.

  • CCN 231973 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 231973

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
HEART OF THE CITY HEALTH CENTER WEST
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 3, 2012
Last certification
May 3, 2012
Ownership / control type
For profit – corporation
Facility address
201 Sheldon Ave
Grand Rapids, MI 49503
Related CCNs
231809

National Provider Directory

National Provider Directory
Part of
Cherry Streat Health Services

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640736000000",
    "number": "1013292580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034526",
            "telephone_number": "616-965-8200",
            "fax_number": "616-940-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SHELDON BLVD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034513",
            "telephone_number": "616-965-8282",
            "fax_number": "616-940-5366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRY STREET SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHERRY STREET SERVICES INC",
        "enumeration_date": "2011-10-17",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "616-965-8200"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heart of the City Health Center West",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heart of the City Health Center West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.