North Country Health Services Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

47E054 Issued in VT

Legal business name

NORTH COUNTRY HEALTH SERVICES INC

Doing business as

Derby Green

Practice address

2853 US Route 5
Derby, VT 05829-9629

Phone

(802) 766-2201

Fax

(802) 766-2031

NPI assigned

Sep 6, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lisa Ann Bohlman, RN BSN CCM

Title

Administrator

Phone

(802) 766-2126

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Derby Green Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730173741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24",
            "address_2": "2853 US RTE 5",
            "city": "DERBY",
            "state": "VT",
            "postal_code": "058290024",
            "telephone_number": "802-766-2201",
            "fax_number": "802-766-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2853 US ROUTE 5",
            "city": "DERBY",
            "state": "VT",
            "postal_code": "058299629",
            "telephone_number": "802-766-2201",
            "fax_number": "802-766-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH COUNTRY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOHLMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "802-766-2126",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN BSN CCM"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VT",
            "license": "47E054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "475048",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Derby Green",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Derby, VT
• Providers in Derby, VT by specialty
• Skilled Nursing Facility in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.