CHERRY STREET SERVICES INC NPI 1184974263

NPI Information

NPI: 1184974263
Provider Name: CHERRY STREET SERVICES INC

Doing Business As: WYOMING COMMUNITY HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 23D2047786

Address:
2929 BURLINGAME AVE SW
WYOMING, MI
ZIP 49509
Phone: (616) 965-8333
Get Directions

CHERRY STREET SERVICES INC is a federally qualified health center (fqhc) clinic center in Wyoming, MI. CHERRY STREET SERVICES INC NPI is 1184974263. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Wyoming Community Health Center.

The provider's business location address is:

2929 BURLINGAME AVE SW
WYOMING, MI
ZIP 49509-609
Phone: (616) 965-8333
Fax: (616) 940-5820

The provider's authorized official is Tasha Blackmon .
The authorized official title is Ceo and has the following contact phone number (616) 965-8200.

The CLIA number assigned to this NPI record is 23D2047786 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/14/2012 and was last updated on 12/29/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YM0800X	Counselor	Mental Health	No
2	103TB0200X	Psychologist	Cognitive & Behavioral	No
3	103TC0700X	Psychologist	Clinical	No
4	103TP2701X	Psychologist	Group Psychotherapy	No
5	104100000X	Social Worker		No
6	122300000X	Dentist		No
7	133V00000X	Dietitian, Registered		No
8	156FX1800X	Technician/Technologist	Optician	No
9	163W00000X	Registered Nurse		No
10	207Q00000X	Family Medicine		No
11	207R00000X	Internal Medicine		No
12	207W00000X	Ophthalmology		No
13	208000000X	Pediatrics		No
14	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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