Provider Demographics
NPI:1760427843
Name:HEALTHRIGHT 360
Entity Type:Organization
Organization Name:HEALTHRIGHT 360
Other - Org Name:HAIGHT ASHBURY FREE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
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 STREET, 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 1:558 CLAYTON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2907
Practice Address - Country:US
Practice Address - Phone:415-226-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
CA220000030261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11599FMedicaid
CA551111Medicare Oscar/Certification