Provider Demographics
NPI:1811641145
Name:PROACTIVE HEALTH CARE MANAGEMENT,LLC
Entity type:Organization
Organization Name:PROACTIVE HEALTH CARE MANAGEMENT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-895-4360
Mailing Address - Street 1:46 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7877
Mailing Address - Country:US
Mailing Address - Phone:203-895-4360
Mailing Address - Fax:
Practice Address - Street 1:46 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-7877
Practice Address - Country:US
Practice Address - Phone:203-895-4360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty