Healthcare Provider Details

I. General information

NPI: 1811641145
Provider Name (Legal Business Name): PROACTIVE HEALTH CARE MANAGEMENT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 SOUNDVIEW AVE
MILFORD CT
06460-7877
US

IV. Provider business mailing address

46 SOUNDVIEW AVE
MILFORD CT
06460-7877
US

V. Phone/Fax

Practice location:
  • Phone: 203-895-4360
  • Fax:
Mailing address:
  • Phone: 203-895-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANI GRAY
Title or Position: OWNER
Credential: APRN
Phone: 203-895-4360