Provider Demographics
NPI:1730173741
Name:NORTH COUNTRY HEALTH SERVICES INC
Entity type:Organization
Organization Name:NORTH COUNTRY HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN CCM
Authorized Official - Phone:802-766-2126
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:2853 US RTE 5
Mailing Address - City:DERBY
Mailing Address - State:VT
Mailing Address - Zip Code:05829-0024
Mailing Address - Country:US
Mailing Address - Phone:802-766-2201
Mailing Address - Fax:802-766-2031
Practice Address - Street 1:2853 US ROUTE 5
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:VT
Practice Address - Zip Code:05829-9629
Practice Address - Country:US
Practice Address - Phone:802-766-2201
Practice Address - Fax:802-766-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT47E054314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT475048Medicaid
VT475048Medicaid