NPIMap

Organization Active NPI

Waterfall Clinic, Incorporated

Doing business as Waterfall Behavorial Health Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Coos Bay, OR
National Provider Identifier
1619673704
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
WATERFALL CLINIC, INCORPORATED
Doing business as
Waterfall Behavorial Health Center
Practice address
1300 N Bayshore Drive
Suite 202
Coos Bay, OR 97420
Phone
(541) 756-6232
Fax
(541) 756-6234
NPI assigned
Feb 1, 2023
Last updated
Feb 1, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WATERFALL CLINIC, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teresea Colleen Bratcher
Title
Finance Manager
Phone
(541) 756-6232

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

1300 N Bayshore Drive
Suite 202
Coos Bay, OR 97420

Mailing address

1890 Waite St Ste 1
North Bend, OR 97459-1229
Phone (541) 435-7022

Other names 1

  • Waterfall Behavorial Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040827000153 OR Part B Supplier - Clinic/Group Practice 5698740355 Receives reassigned benefits from 38 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coos Bay, OR; North Bend, OR
O20250912004236 OR Part A Provider - Federally Qualified Health Center (FQHC) 5698740355 Practice locations: Coos Bay, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619673704. Details of each certification follow.

Federally qualified health center certification: CCN 381053

Legal name
WATERFALL CLINIC INCORPORATED
Doing business as
WATERFALL BEHAVIORAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 24, 2025
Last certification
Oct 24, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1300 N Bayshore Dr
Ste 202
Coos Bay, OR 97420-2526

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Waterfall Community Health Center8 organizations share this tax ID, including this one
Part of
Waterfall Community Health Center

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1300 N Bayshore Dr
#202
Coos Bay, OR 97420
Phone (541) 435-7000

465 Elrod Ave
Ste 101
Coos Bay, OR 97420
Phone (541) 751-7948

755 S 7th St
Coos Bay, OR 97420
Phone (541) 267-1400

1890 Waite St
Ste 3
North Bend, OR 97459
Phone (541) 756-2341

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joe Madden Individual Corporate DirectorDirector of Clinical Services Oct 7, 2025
Carmen Randolph Individual Corporate DirectorDirector of Operations Oct 7, 2025
Steve Sanden Individual Corporate DirectorBoard Director Feb 1, 2023
Jordan McLaren Individual W-2 Managing EmployeeProvider Specialist/Project Manager Feb 1, 2023
Ruth Bell Individual Corporate DirectorBoard Director Feb 1, 2023
Leslie Ryan Individual Corporate DirectorBoard Secretary Feb 1, 2023
Arnold Roblan Individual Corporate DirectorBoard Treasurer Feb 1, 2023
Brittiney Vogt Individual W-2 Managing EmployeeCredentialing Specialist Nov 1, 2024
Marcelene Knight Individual Corporate DirectorBoard President Feb 1, 2023
Karen B Sheelar Individual Corporate OfficerCbho Feb 1, 2023
McClain Altman Individual Corporate DirectorBoard Director Feb 1, 2023
Anna Huit Individual Corporate DirectorBoard Vice President Feb 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Waterfall School Based Health CenterCoos Bay, OR, CCN 381950 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 16, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1619673704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 WAITE ST STE 1",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974591229",
            "telephone_number": "541-435-7022",
            "fax_number": "541-435-7038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N BAYSHORE DRIVE",
            "address_2": "SUITE 202",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "97420",
            "telephone_number": "541-756-6232",
            "fax_number": "541-756-6234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFALL CLINIC, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATERFALL CLINIC, INCORPORATED",
        "enumeration_date": "2023-02-01",
        "last_updated": "2023-02-01",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "BRATCHER",
        "authorized_official_first_name": "TERESEA",
        "authorized_official_middle_name": "COLLEEN",
        "authorized_official_title_or_position": "FINANCE MANAGER",
        "authorized_official_telephone_number": "541-756-6232"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterfall Behavorial Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coos Bay, OR

Sources for this page

Verify at the official NPI Registry.