Provider Demographics
NPI:1619673704
Name:WATERFALL CLINIC, INCORPORATED
Entity Type:Organization
Organization Name:WATERFALL CLINIC, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESEA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-756-6232
Mailing Address - Street 1:1890 WAITE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1229
Mailing Address - Country:US
Mailing Address - Phone:541-435-7022
Mailing Address - Fax:541-435-7038
Practice Address - Street 1:1300 N BAYSHORE DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-756-6232
Practice Address - Fax:541-756-6234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WATERFALL CLINIC, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty