Healthcare Provider Details

I. General information

NPI: 1447558226
Provider Name (Legal Business Name): HEALTHRIGHT 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MIRAMONTE AVE 2ND FLOOR
MOUNTAIN VIEW CA
94040-2457
US

IV. Provider business mailing address

1735 MISSION ST
SAN FRANCISCO CA
94103-2417
US

V. Phone/Fax

Practice location:
  • Phone: 650-965-3323
  • Fax: 650-965-0706
Mailing address:
  • Phone: 415-762-3712
  • Fax: 415-865-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. VITKA EISEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 415-762-1558