Provider Demographics
NPI:1447279310
Name:HEALTHRIGHT 360
Entity type:Organization
Organization Name:HEALTHRIGHT 360
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VITKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-762-3700
Mailing Address - Street 1:1563 MISSION ST, 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2543
Mailing Address - Country:US
Mailing Address - Phone:415-762-3700
Mailing Address - Fax:415-865-0119
Practice Address - Street 1:330 ELLIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2735
Practice Address - Country:US
Practice Address - Phone:415-674-6142
Practice Address - Fax:415-885-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000473261QF0400X, 261QP0904X
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA091070OtherFQHC UDS
CA220000473OtherCOMMUNITY CLINIC LICENSE
CA051000Medicare Oscar/Certification
CAGR0099180Medicaid