Healthcare Provider Details

I. General information

NPI: 1447279310
Provider Name (Legal Business Name): HEALTHRIGHT 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ELLIS ST
SAN FRANCISCO CA
94102-2735
US

IV. Provider business mailing address

1563 MISSION ST, 4TH FLOOR
SAN FRANCISCO CA
94103-2543
US

V. Phone/Fax

Practice location:
  • Phone: 415-674-6142
  • Fax: 415-885-8512
Mailing address:
  • Phone: 415-762-3700
  • Fax: 415-865-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number220000473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number220000473
License Number StateCA

VIII. Authorized Official

Name: VITKA EISEN
Title or Position: CEO
Credential:
Phone: 415-762-3700