NPIMap

Organization Active NPI

Cherry Street Services, Inc

Doing business as Barry Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Hastings, MI
National Provider Identifier
1447760517
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
Barry Community Health Center
Cherry Health - Barry Community Health Center
Practice address
200 S Boltwood St
Hastings, MI 49058
Phone
(269) 945-4220
Fax
(269) 945-4229
NPI assigned
Oct 3, 2017
Last updated
Aug 25, 2023By 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 Aug 25, 2023

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) 965-8215

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Clinical Social Worker 1041C0700X NU
Dentist 122300000X NU
Registered Nurse 163W00000X NU
Family Medicine Physician 207Q00000X NU
Adult Medicine Physician 207QA0505X NU
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

200 S Boltwood St
Hastings, MI 49058

Mailing address

100 Cherry St SE
Grand Rapids, MI 49503-4526
Phone (616) 965-8209

Other names 2

  • Barry Community Health Center Doing business as
  • Cherry Health - Barry Community 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
O20180116000097 MI Part A Provider - Federally Qualified Health Center (FQHC) 6800707647 Practice locations: Hastings, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447760517. Details of each certification follow.

Federally qualified health center certification: CCN 231122

Legal name
CHERRY STREET SERVICES INC
Doing business as
BARRY COMMUNITY HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1988 in MI
Enrollment address
200 S Boltwood St
Hastings, MI 49058-1993

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

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
23D2071119Barry Community Health Center200 S Boltwood Street, Hastings, MI 49058Provider-performed microscopyJan 2, 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

Locations

200 S Boltwood St
Hastings, MI 49058
Phone (269) 945-4220

Ownership & related parties

All disclosed owners & managing parties 18

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 Nov 8, 2017
W-2 Managing Employee Nov 8, 2017
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
Cherry Street Services Inc Organization, Grand Rapids, MI Corporation, Non-profit Operational/Managerial Control Dec 1, 2017
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 21

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

View all 21

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1447760517",
    "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": "616-965-8209",
            "fax_number": "269-945-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S BOLTWOOD ST",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "49058",
            "telephone_number": "269-945-4220",
            "fax_number": "269-945-4229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRY STREET SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHERRY STREET SERVICES, INC.",
        "enumeration_date": "2017-10-03",
        "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": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "616-965-8215"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Barry Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cherry Health - Barry Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hastings, MI

Sources for this page

Verify at the official NPI Registry.