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EASTLAKE TERRACE
NPI 1245610989
Assisted Living Facility in Elkhart, IN

Active since June 08, 2015CLIA 15D2034091 · Waiver
3109 E BRISTOL ST, ELKHART, IN 46514(317) 324-9562 Get Directions Write a Review

NPPES record last updated: June 8, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Eastlake Terrace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EASTLAKE TERRACE (NPI 1245610989) is a healthcare organization registered as an assisted living facility in Elkhart, Indiana and active in the NPI registry since June 2015. The organization holds a CLIA Waiver certificate valid through December 15, 2027 and lists Danny Prosky, Authorized Representative, as its authorized official.

NPPES Registry Identity

NPI1245610989
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameGAHC3 ELKHART IN ALF TRS SUB, LLC
Location Address3109 E BRISTOL STElkhart, IN 46514-4372
Mailing Address3109 E Bristol StElkhart, IN 46514-4372 · (317) 324-9562
Phone(317) 324-9562
Organization SubpartNo
Authorized OfficialDanny ProskyAuthorized Representative · (949) 270-9200
Enumeration DateJune 8, 2015
✔ NPI 1245610989 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
3109 E BRISTOL ST, Elkhart, IN 46514
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Other Names 1

Doing Business AsEastlake Terrace

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2034091

Gahc3 Elkhart In Alf Trs Sub LLC · Elkhart, IN
Active · expires Dec 15, 2027
CLIA Number15D2034091
Laboratory TypeAssisted Living Facility
Certificate Effective DateDecember 16, 2025
Certificate Expiration DateDecember 15, 2027
Laboratory DirectorStephanie K. Maupin
Laboratory Phone(574) 266-4508
Laboratory LocationGahc3 Elkhart In Alf Trs Sub LLC3109 E Bristol St, Elkhart, IN 46514
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAVID PEACHEY
Physical Therapy Assistant
3109 E BRISTOL ST
ELKHART, IN 46514
Elkhart County (574) 264-5649
ALLISON K MILLER MS, OTR/L
Occupational Therapist
3109 E BRISTOL ST
ELKHART, IN 46514
Elkhart County (574) 266-4508
WESTON REHABILITATION INDIANA LLC
Physical Therapist
3109 E BRISTOL ST
ELKHART, IN 46514
Elkhart County (574) 266-4508
STEPHANIE L CUNDIFF COTA
Occupational Therapy Assistant
3109 E BRISTOL ST
ELKHART, IN 46514
Elkhart County (574) 266-4508
ALICIA RANEE DAVIDSON-CREEKMORE COTA/L
Occupational Therapy Assistant
3109 E BRISTOL ST
ELKHART, IN 46514
Elkhart County (574) 584-3324
JAMILA IFE ROBERTS PTA
Physical Therapy Assistant
3109 E BRISTOL ST
ELKHART, IN 46514
Elkhart County (574) 330-4004
STACIE DEMPSEY PTA
Physical Therapy Assistant
3109 E BRISTOL ST
ELKHART, IN 46514
Elkhart County (574) 330-4004
ARV ASSISTED LIVING, INC.
Assisted Living Facility
3109 E BRISTOL ST
ELKHART, IN 46514
Elkhart County (574) 266-4508

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gahc3 Elkhart In Alf Trs Sub, LLC's NPI number?

The NPI number for Gahc3 Elkhart In Alf Trs Sub, LLC is 1245610989. It was assigned to this organization in the NPPES registry on June 8, 2015. The provider is doing business as Eastlake Terrace.

Where is Gahc3 Elkhart In Alf Trs Sub, LLC located?

Gahc3 Elkhart In Alf Trs Sub, LLC is located at 3109 E Bristol St, Elkhart, IN 46514. The listed phone number is (317) 324-9562.

What is Gahc3 Elkhart In Alf Trs Sub, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Gahc3 Elkhart In Alf Trs Sub, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2034091) is associated with this NPI, valid through December 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Gahc3 Elkhart In Alf Trs Sub, LLC was last updated on June 8, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.