Healthcare Provider Details

I. General information

NPI: 1417090341
Provider Name (Legal Business Name): HEALTHRIGHT 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 DONNER AVE STE 3
SAN FRANCISCO CA
94124-3277
US

IV. Provider business mailing address

1563 MISSION ST FL 4
SAN FRANCISCO CA
94103-2592
US

V. Phone/Fax

Practice location:
  • Phone: 415-762-3700
  • Fax:
Mailing address:
  • Phone: 415-762-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. VITKA EISEN
Title or Position: CEO
Credential: MSW, ED.D
Phone: 415-762-3700