SOUTHSIDE HEALTH CENTER – NPI #1386926004
Clinic/Center

SOUTHSIDE HEALTH CENTER is an AHC clinic located in GRAND RAPIDS, MI. NPPES has assigned the NPI number 1386926004 to SOUTHSIDE HEALTH CENTER on September 20, 2011. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “SOUTHSIDE HEALTH CENTER” is a dba name, the actual legal business name for this organization is CHERRY STREET SERVICES INC. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC) Keep in mind, having a taxonomy code selected doesn't replace any credentialing or validation process that may be required by law.

The NPI profile was previously updated about 3 years ago on Aug 25, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTHSIDE HEALTH CENTER below.

NPI Profile for
CHERRY STREET SERVICES INC

NPI Number
1386926004
Enumeration Date

(more than 14 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CHERRY STREET SERVICES INC
Doing Business As (dba): SOUTHSIDE HEALTH CENTER
Primary location
2303 KALAMAZOO AVE SE
GRAND RAPIDS, MI 49507-3780
Phone: (616) 965-8390 Fax: (616) 254-8192
Mailing address
100 CHERRY ST SE
GRAND RAPIDS, MI 49503-4526
Phone: (616) 965-8200 Fax:
Organization Subpart
Yes - SOUTHSIDE HEALTH CENTER is subpart of another organization.
Authorized Official
TASHA BLACKMON
CEO
Phone: (616) 965-8215
Updated
Certification Date
Aug 25, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.