Provider Demographics
NPI:1568556363
Name:HEALTHRIGHT 360
Entity Type:Organization
Organization Name:HEALTHRIGHT 360
Other - Org Name:LYON MARTIN HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VITKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, EDD
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:415-762-3712
Mailing Address - Fax:415-865-0119
Practice Address - Street 1:1735 MISSION ST FL 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2417
Practice Address - Country:US
Practice Address - Phone:415-565-7667
Practice Address - Fax:415-252-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000121261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80240FMedicaid
CA80240FMedicaid
CAHAP80240FOtherFPACT
CAG92555Medicare UPIN
CAECP70031FOtherEAPC