Healthcare Provider Details

I. General information

NPI: 1982982120
Provider Name (Legal Business Name): HEALTHRIGHT 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 EDUCATIONAL PARK DR
SAN JOSE CA
95133-1739
US

IV. Provider business mailing address

1735 MISSION ST
SAN FRANCISCO CA
94103-2417
US

V. Phone/Fax

Practice location:
  • Phone: 408-928-9300
  • Fax:
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 TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health 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