NPIMap

Organization Active NPI

Cherry Street Services Inc

Doing business as Muskegon Recovery Center

  • Federally Qualified Health Center (FQHC)
  • Muskegon, MI
National Provider Identifier
1346600905
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHERRY STREET SERVICES INC
Doing business as
Muskegon Recovery Center
Practice address
1611 Oak Ave
Muskegon, MI 49442-2468
Phone
(616) 965-8200
Fax
(616) 940-5366
NPI assigned
Feb 25, 2016
Last updated
Aug 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CHERRY STREET SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Tasha Blackmon, CEO
Title
Ceo
Phone
(616) 965-8215

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X
Addiction Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LA0401X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1611 Oak Ave
Muskegon, MI 49442-2468

Mailing address

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

Other names 1

  • Muskegon Recovery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments
Opioid treatment program
Medicare-enrolled since Mar 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170105000134 MI Part A Provider - Federally Qualified Health Center (FQHC) 6800707647 Practice locations: Muskegon, MI
O20200409000139 MI Part B Supplier - Opioid Treatment Program (Otp) 6800707647 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Rapids, MI; Muskegon, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346600905. Details of each certification follow.

Federally qualified health center certification: CCN 231103

Legal name
CHERRY STREET SERVICES INC
Doing business as
MUSKEGON RECOVERY CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 21, 2016
Last certification
Dec 21, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 21, 1988 in MI
Enrollment address
1611 Oak Ave
Muskegon, MI 49442-2468

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2110929Cherry Health Muskegon Recovery Center1611 Oak Avenue, Muskegon, MI 49442Certificate of waiverMar 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Employee Assistance Center Fulton29 organizations share this tax ID, including this one
Part of
Employee Assistance Center Fulton

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elizabeth Triezenberg Individual Corporate DirectorBoard Member Nov 30, 2016
Allen Tenhoor Individual Corporate DirectorBoard Member Nov 30, 2016
Ziyadah Shakir Individual Corporate DirectorBoard Member Nov 30, 2016
Allison Swets Individual Corporate DirectorBoard Member Nov 30, 2016
Esperanza Degnan Individual Corporate DirectorBoard Member Jan 1, 2023
Richard Stevens Individual Corporate DirectorBoard Member Nov 30, 2016
Tasha Blackmon Individual Corporate OfficerCeo Jan 1, 2018
W-2 Managing EmployeeCeo Jan 1, 2018
Margaret McGuiness Individual Corporate DirectorBoard Member Nov 30, 2016
David Smith Individual Corporate DirectorBoard Member Nov 30, 2016
Barbara Wybrecht Individual Corporate DirectorBoard Member Nov 30, 2016
Gwynn Bult Individual Corporate DirectorBoard Member Jan 1, 2023
Evelyn Esparza-Gonzales Individual Corporate DirectorBoard Member Jan 1, 2023
Francena Purchase-Owens Individual Corporate DirectorBoard Member Jan 1, 2023
Kimberly Lavender Individual Corporate DirectorBoard Member Nov 30, 2016
Leslie King Individual Corporate DirectorBoard Member Jan 1, 2023
Scott David Alfree Individual Corporate DirectorBoard Member Nov 30, 2016
Carol Dickinson Individual Corporate DirectorBoard Member Nov 30, 2016

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Barry Community Health CenterHastings, MI, CCN 231122 Federally qualified health center Operational/Managerial Control Dec 1, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1456358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1346600905",
    "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": "1611 OAK AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494422468",
            "telephone_number": "616-965-8200",
            "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": "2016-02-25",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "616-965-8215",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Muskegon Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Muskegon Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.