Gahc3 Elkhart in Alf TRS Sub, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GAHC3 ELKHART IN ALF TRS SUB, LLC

Doing business as

Eastlake Terrace

Practice address

3109 E Bristol St
Elkhart, IN 46514-4372

Phone

(317) 324-9562

NPI assigned

Jun 8, 2015

Last updated

Jun 8, 2015By 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

Danny Prosky

Title

Authorized Representative

Phone

(949) 270-9200

Specialties & licenses 1

Addresses

Other names 1

• Eastlake Terrace Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433721600000",
    "number": "1245610989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 E BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465144372",
            "telephone_number": "317-324-9562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 E BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465144372",
            "telephone_number": "317-324-9562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAHC3 ELKHART IN ALF TRS SUB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-08",
        "last_updated": "2015-06-08",
        "status": "A",
        "authorized_official_last_name": "PROSKY",
        "authorized_official_first_name": "DANNY",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "949-270-9200"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastlake Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Austin Fritzgerald
• Emily Fayeth Fry-Schutt, PHARMD
• Sara L Fry
• Dawn Marie Fulmer, R.D.
• Gabriele Eye Institute
• Katharine L Gaj, DPT, OCS, COMT, ATC
• Sean-Robin Galvan, PA-C
• Kenneth L. Gammon, M.D.
• Alma Gandara
• Emma Gangwer

• Assisted Living Facility in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Assisted Living Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.