Healthcare Provider Details

I. General information

NPI: 1376117663
Provider Name (Legal Business Name): SHIFT SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6697 ELM ST
NORTH BRANCH MN
55056-7045
US

IV. Provider business mailing address

6697 ELM ST
NORTH BRANCH MN
55056-7045
US

V. Phone/Fax

Practice location:
  • Phone: 651-428-2797
  • Fax:
Mailing address:
  • Phone: 651-428-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA M KORTUS
Title or Position: CEO
Credential:
Phone: 651-428-2797