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PROACTIVE WOUND CARE ID, INC.

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Company Details

Name: PROACTIVE WOUND CARE ID, INC.
Jurisdiction: Idaho
Legal type: Foreign Business Corporation
Status: Active-Good Standing
Date of registration: 06 Nov 2024 (10 months ago)
Financial Date End: 30 Nov 2025
Entity Number: 5968876
Place of Formation: UTAH
File Number: 962680
Principal Address: KELLY C. PAYNE 380 SOUTH MAIN STREET CENTERVILLE, UT 84014
Mailing Address: KELLY C. PAYNE 380 S MAIN ST CENTERVILLE, UT 84014-2266

Agent

Name Role Address
KELLY C PAYNE Agent 2270 HWY 89, FISH HAVEN, ID 83287

National Provider Identifier

NPI Number:
1134928419
Certification Date:
2025-03-10

Authorized Person:

Name:
HAYLEY WILLIAMS
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
213E00000X - Podiatrist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0005968876 2024-11-06

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Date of last update: 24 Aug 2025

Sources: Idaho Secretary of State