Provider Demographics
NPI:1376117663
Name:SHIFT SOLUTIONS
Entity Type:Organization
Organization Name:SHIFT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KORTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-428-2797
Mailing Address - Street 1:6697 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-7045
Mailing Address - Country:US
Mailing Address - Phone:651-428-2797
Mailing Address - Fax:
Practice Address - Street 1:6697 ELM ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-7045
Practice Address - Country:US
Practice Address - Phone:651-428-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty