Healthcare Provider Details

I. General information

NPI: 1023170362
Provider Name (Legal Business Name): HEALTHRIGHT 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HAYES ST
SAN FRANCISCO CA
94117-1128
US

IV. Provider business mailing address

1563 MISSION ST, 5TH FLOOR
SAN FRANCISCO CA
94103-2543
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5125
  • Fax: 415-386-2048
Mailing address:
  • Phone: 415-762-3712
  • Fax: 415-865-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

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