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General NPI Number Information
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NPI Number | 1154495901
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Entity Type | Organization
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Legal Business Name | CHERRY STREET SERVICES, INC.
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 751 LAFAYETTE AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1628
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Country | US
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Telephone | 616-742-9945
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Fax | 616-742-9967
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Provider Business Mailing Address
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Address Line | 100 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4526
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Country | US
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Telephone | 616-776-2370
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Fax | 616-776-2371
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Authorized Official
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Title or Position | CEO
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Name | CHRIS SHEA
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Credential |
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Telephone | 616-776-2129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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