NPIMap

Organization Active NPI

Cherry Street Services, Inc.

Doing business as Cherry Health - Cedar Springs High School Health Center

  • Federally Qualified Health Center (FQHC)
  • Cedar Springs, MI
National Provider Identifier
1386492171
Registry record updated May 8, 2024
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
Cherry Health - Cedar Springs High School Health Center
Practice address
204 E Muskegon St
Cedar Springs, MI 49319-9326
Phone
(616) 696-3470
NPI assigned
May 8, 2024
Last updated
May 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CHERRY STREET SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Tasha Blackmon
Title
Ceo
Phone
(616) 965-8200

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X
Community Health Worker 172V00000X

Addresses

Primary practice location

204 E Muskegon St
Cedar Springs, MI 49319-9326

Mailing address

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

Other names 1

  • Cherry Health - Cedar Springs High School Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240611002533 MI Part A Provider - Federally Qualified Health Center (FQHC) 6800707647 Practice locations: Cedar Springs, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386492171. Details of each certification follow.

Federally qualified health center certification: CCN C71024

Legal name
CHERRY STREET SERVICES INC
Doing business as
CHERRY HEALTH - CEDAR SPRINGS HIGH SCHOOL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 10, 2024
Last certification
Jun 10, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
204 E Muskegon St
Cedar Springs, MI 49319-9326

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

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 Director May 8, 2024
Allen Tenhoor Individual Corporate DirectorBoard Director May 8, 2024
Ziyadah Shakir Individual Corporate DirectorBoard Director May 8, 2024
Allison Swets Individual Corporate DirectorBoard Director May 8, 2024
Esperanza Degnan Individual Corporate DirectorBoard Director May 8, 2024
Richard Stevens Individual Corporate DirectorBoard Director May 8, 2024
Tasha Blackmon Individual Corporate OfficerCeo May 8, 2024
W-2 Managing EmployeeAd; May 8, 2024
Margaret McGuiness Individual Corporate DirectorBoard Director May 8, 2024
David Smith Individual Corporate DirectorBoard Director May 8, 2024
Barbara Wybrecht Individual Corporate DirectorBoard Director May 8, 2024
Gwynn Bult Individual Corporate DirectorBoard Director May 8, 2024
Evelyn Esparza-Gonzales Individual Corporate DirectorBoard Director May 8, 2024
Francena Purchase-Owens Individual Corporate DirectorBoard Director May 8, 2024
Kimberly Lavender Individual Corporate DirectorBoard Director May 8, 2024
Leslie King Individual Corporate DirectorBoard Director May 8, 2024
Scott David Alfree Individual Corporate DirectorBoard Director May 8, 2024
Carol Dickinson Individual Corporate DirectorBoard Director May 8, 2024

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": "1715126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1386492171",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E MUSKEGON ST",
            "city": "CEDAR SPRINGS",
            "state": "MI",
            "postal_code": "493199326",
            "telephone_number": "616-696-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRY STREET SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHERRY STREET SERVICES, INC.",
        "enumeration_date": "2024-05-08",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "616-965-8200"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherry Health - Cedar Springs High School Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedar Springs, MI

Sources for this page

Verify at the official NPI Registry.