NPIMap

Organization Active NPI

Cherry Street Services, Inc

Doing business as Godwin Heights Senior High School Health Center

  • Federally Qualified Health Center (FQHC)
  • Grand Rapids, MI
National Provider Identifier
1609555218
Registry record updated Jul 12, 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
Godwin Heights Senior High School Health Center
Practice address
50 35TH St SW
Grand Rapids, MI 49548-2100
Phone
(616) 965-8200
NPI assigned
Jul 12, 2023
Last updated
Jul 12, 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 Jul 12, 2023

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 15

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Counselor 101Y00000X NU
School Counselor 101YS0200X NU
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU
School Social Worker 1041S0200X NU
Dentist 122300000X NU
Dental Hygienist 124Q00000X NU
Dental Assistant 126800000X NU
Registered Dietitian 133V00000X NU
Optometrist 152W00000X NU
School Registered Nurse 163WS0200X NU
Family Medicine Physician 207Q00000X NU
Pediatrics Physician 208000000X NU
Dental Therapist 125J00000X NU

Addresses

Primary practice location

50 35TH St SW
Grand Rapids, MI 49548-2100

Mailing address

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

Other names 1

  • Godwin Heights Senior 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
O20230927001593 MI Part A Provider - Federally Qualified Health Center (FQHC) 6800707647 Practice locations: Grand Rapids, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609555218. Details of each certification follow.

Federally qualified health center certification: CCN C71006

Legal name
CHERRY STREET SERVICES INC
Doing business as
GODWIN HEIGHTS SENIOR HIGH SCHOOL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 20, 2023
Last certification
Sep 20, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
50 35TH St SW
Grand Rapids, MI 49548-2100

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
23D2293834Godwin Heights Senior High School Health Center50 35TH Street SW, Grand Rapids, MI 49548Certificate of waiverNov 14, 2027

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

50 35th St SW
Grand Rapids, MI 49548
Phone (616) 776-5110

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 Aug 14, 2023
Allen Tenhoor Individual Corporate DirectorBoard Member Aug 14, 2023
Ziyadah Shakir Individual Corporate DirectorBoard Member Aug 14, 2023
Allison Swets Individual Corporate DirectorBoard Member Aug 14, 2023
Esperanza Degnan Individual Corporate DirectorBoard Member Aug 14, 2023
Richard Stevens Individual Corporate DirectorBoard Member Aug 14, 2023
Tasha Blackmon Individual Corporate OfficerCeo Aug 14, 2023
W-2 Managing EmployeeCeo Aug 14, 2023
Margaret McGuiness Individual Corporate DirectorBoard Member Aug 14, 2023
David Smith Individual Corporate DirectorBoard Member Aug 14, 2023
Barbara Wybrecht Individual Corporate DirectorBoard Member Aug 14, 2023
Gwynn Bult Individual Corporate DirectorBoard Member Aug 14, 2023
Evelyn Esparza-Gonzales Individual Corporate DirectorBoard Member Aug 14, 2023
Francena Purchase-Owens Individual Corporate DirectorBoard Member Aug 14, 2023
Kimberly Lavender Individual Corporate DirectorBoard Member Aug 14, 2023
Leslie King Individual Corporate DirectorBoard Member Aug 14, 2023
Scott David Alfree Individual Corporate DirectorBoard Member Aug 14, 2023
Carol Dickinson Individual Corporate DirectorBoard Member Aug 14, 2023

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.

Practitioners & affiliated clinicians

Practitioners 5

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": "1689120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1609555218",
    "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": "616-940-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 35TH ST SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495482100",
            "telephone_number": "616-965-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRY STREET SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHERRY STREET SERVICES, INC",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-07",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Godwin Heights Senior High School Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.