MEDICARE: HEALTHRIGHT 360

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295092815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHRIGHT 360

Provider Business Mailing Address
First Line	:	1735 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-2417
Country	:	US
Telephone Number	:	415-762-3712
Fax Number	:	415-865-0119

Provider Business Practice Location Address
First Line	:	2290 14TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1841
Country	:	US
Telephone Number	:	415-776-1001
Fax Number	:	415-776-1066

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. VITKA EISEN
Credential	:
Telephone Number	:	415-762-1558

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	01/17/2014

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Directions to “HEALTHRIGHT 360 ” Practice Location

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