Healthcare Provider Details

I. General information

NPI: 1730173741
Provider Name (Legal Business Name): NORTH COUNTRY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2853 US ROUTE 5
DERBY VT
05829-9629
US

IV. Provider business mailing address

PO BOX 24 2853 US RTE 5
DERBY VT
05829-0024
US

V. Phone/Fax

Practice location:
  • Phone: 802-766-2201
  • Fax: 802-766-2031
Mailing address:
  • Phone: 802-766-2201
  • Fax: 802-766-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number47E054
License Number StateVT

VIII. Authorized Official

Name: MRS. LISA ANN BOHLMAN
Title or Position: ADMINISTRATOR
Credential: RN BSN CCM
Phone: 802-766-2126