Provider Demographics
NPI:1578979274
Name:CHERRY STREET HEALTH SERVICES
Entity Type:Organization
Organization Name:CHERRY STREET HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORTS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:LLBSW
Authorized Official - Phone:616-965-8200
Mailing Address - Street 1:100 CHERRY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4526
Mailing Address - Country:US
Mailing Address - Phone:616-965-8200
Mailing Address - Fax:616-940-5357
Practice Address - Street 1:100 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4526
Practice Address - Country:US
Practice Address - Phone:616-965-8200
Practice Address - Fax:616-940-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088180251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management