Organization
GAHC3 MISHAWAKA IN ALF TRS SUB, LLC
Active
Other names
Tanglewood Trace
Organization subpart
No
Provider details
NPI number
Authorized official
DANNY PROSKY (AUTHORIZED REPRESENTATIVE)
(949) 270-9200
Entity
Organization
Contact information
Practice address
530 TANGLEWOOD LN, MISHAWAKA, IN 46545-2627
(317) 324-9563
Mailing address
530 TANGLEWOOD LN, MISHAWAKA, IN 46545-2627
(317) 324-9563
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
06/08/2015
Last updated
06/08/2015
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