Basic Information
| Provider Information | |||||||||
| NPI: | 1356643993 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHRIGHT 360 | ||||||||
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| OtherOrganizationName: | PROTOTYPES CENTERS FOR INNOVATION IN HEALTH, MENTAL HEALTH AND SOCIAL | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1563 MISSION ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2135423838 | ||||||||
| FaxNumber: | 2132250085 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N ALAMEDA ST | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900121804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2135423838 | ||||||||
| FaxNumber: | 2132250085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2010 | ||||||||
| LastUpdateDate: | 08/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | EISEN | ||||||||
| AuthorizedOfficialFirstName: | VITKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 2135423838 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.