=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144363086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHRIGHT 360
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 10/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 890 HAYES ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94117-2615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-701-5100
-----------------------------------------------------
Fax | 415-621-1033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1735 MISSION ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94103-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-762-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | VITKA EISEN
-----------------------------------------------------
Credential | MSW, ED.D
-----------------------------------------------------
Telephone | 415-762-3712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 380016AFN
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------