Healthcare Provider Details

I. General information

NPI: 1730564386
Provider Name (Legal Business Name): WATERFALL COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 BUTTE FALLS HWY
EAGLE POINT OR
97524-4463
US

IV. Provider business mailing address

2299 BUTTE FALLS HWY
EAGLE POINT OR
97524-4463
US

V. Phone/Fax

Practice location:
  • Phone: 541-951-7723
  • Fax:
Mailing address:
  • Phone: 541-951-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number7062
License Number StateOR

VIII. Authorized Official

Name: MRS. ANDREA TRENNER
Title or Position: CEO
Credential:
Phone: 541-756-6232