NPIMap

Organization Active NPI

Cherry Street Services, Inc

Doing business as Cherry Health - Tri County Middle School

  • Federally Qualified Health Center (FQHC)
  • Howard City, MI
National Provider Identifier
1831955251
Registry record updated Feb 23, 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 - Tri County Middle School
Practice address
21350 Kendaville Rd
Howard City, MI 49329-8751
Phone
(231) 937-4318
NPI assigned
Feb 23, 2024
Last updated
Feb 23, 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 Feb 23, 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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Mental Health Counselor 101YM0800X NU
School Counselor 101YS0200X NU
Clinical Social Worker 1041C0700X NU
School Social Worker 1041S0200X NU
Community Health Worker 172V00000X NU

Addresses

Primary practice location

21350 Kendaville Rd
Howard City, MI 49329-8751

Mailing address

100 Cherry St SE
Grand Rapids, MI 49503-4526

Other names 1

  • Cherry Health - Tri County Middle School Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240821003729 MI Part A Provider - Federally Qualified Health Center (FQHC) 6800707647 Practice locations: Howard City, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831955251. Details of each certification follow.

Federally qualified health center certification: CCN C71028

Legal name
CHERRY STREET SERVICES INC
Doing business as
CHERRY HEALTH TRI COUNTY MIDDLE SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 5, 2024
Last certification
Aug 5, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
21350 Kendaville Rd
Howard City, MI 49329-8751

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

Locations

1033 Healthcare Dr
Charlotte, MI 48813
Phone (517) 541-2673

107 Oakes St SE
Grand Rapids, MI 49503
Phone (616) 459-4212

1720 Plainfield Ave NE
Grand Rapids, MI 49505
Phone (214) 717-3953

1800 Tremont Blvd NW
Grand Rapids, MI 49504
Phone (616) 791-6593

2055 Rosewood Ave SE
Grand Rapids, MI 49506
Phone (616) 776-5110

2303 Kalamazoo Ave SE
Ste 200
Grand Rapids, MI 49507
Phone (616) 965-8379

330 Barclay Ave NE
Grand Rapids, MI 49503
Phone (616) 391-8810

330 Barclay Ave NE
Ste GL2
Grand Rapids, MI 49503
Phone (616) 459-4314

75 Sheldon Ave SE
Ste 1
Grand Rapids, MI 49503
Phone (616) 776-2400

75 Sheldon Ave SE
Ste 106
Grand Rapids, MI 49503
Phone (616) 235-7272

1003 N Lafayette St
Greenville, MI 48838
Phone (616) 225-9650

306 S Maplewood St
Greenville, MI 48838
Phone (616) 225-9650

1230 W State St
Hastings, MI 49058

330 W Woodlawn Ave
Hastings, MI 49058
Phone (269) 945-4220

21350 Kendaville Rd
Howard City, MI 49329
Phone (231) 937-4318

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 Jul 22, 2024
Allen Tenhoor Individual Corporate DirectorBoard Director Jul 22, 2024
Ziyadah Shakir Individual Corporate DirectorBoard Director Jul 22, 2024
Allison Swets Individual Corporate DirectorBoard Director Jul 22, 2024
Esperanza Degnan Individual Corporate DirectorBoard Director Jul 22, 2024
Richard Stevens Individual Corporate DirectorBoard Director Jul 22, 2024
Tasha Blackmon Individual Corporate OfficerCeo Jul 22, 2024
W-2 Managing EmployeeCeo Jul 22, 2024
Margaret McGuiness Individual Corporate DirectorBoard Director Jul 22, 2024
David Smith Individual Corporate DirectorBoard Director Jul 22, 2024
Barbara Wybrecht Individual Corporate DirectorBoard Director Jul 22, 2024
Gwynn Bult Individual Corporate DirectorBoard Director Jul 22, 2024
Evelyn Esparza-Gonzales Individual Corporate DirectorBoard Director Jul 22, 2024
Francena Purchase-Owens Individual Corporate DirectorBoard Director Jul 22, 2024
Kimberly Lavender Individual Corporate DirectorBoard Director Jul 22, 2024
Leslie King Individual Corporate DirectorBoard Director Jul 22, 2024
Scott David Alfree Individual Corporate DirectorBoard Director Jul 22, 2024
Carol Dickinson Individual Corporate DirectorBoard Director Jul 22, 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.

Practitioners & affiliated clinicians

Practitioners 162

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.

View all 162

NPI Registry JSON

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

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1831955251",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21350 KENDAVILLE RD",
            "city": "HOWARD CITY",
            "state": "MI",
            "postal_code": "493298751",
            "telephone_number": "231-937-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRY STREET SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHERRY STREET SERVICES, INC.",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "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": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "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": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherry Health - Tri County Middle School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Howard City, MI

Sources for this page

Verify at the official NPI Registry.