Organization
WATERFALL CLINIC, INCORPORATED
Active
Parent organization
WATERFALL CLINIC, INCORPORATED
Other names
Waterfall Healthy Neighbor Team
Organization subpart
Yes
Provider details
NPI number
Legal business name
WATERFALL CLINIC, INCORPORATED
Authorized official
ANDREA TRENNER (CEO)
(541) 756-6232
Entity
Organization
Contact information
Practice address
1890 WAITE ST STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
Mailing address
1890 WAITE ST STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213342
—
OR
Enumeration date
04/02/2020
Last updated
04/02/2020
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