Organization
BEACON OF LIFE NORTH NJ LLC
Active
Other names
BoldAge PACE, BoldAge PACE North NJ
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CZERMAK (CHIEF ADMINISTRATIVE OFFICER)
(855) 801-2653
Entity
Organization
Contact information
Practice address
25 KENNEDY BLVD, E BRUNSWICK, NJ 08816-1259
(732) 806-3205
Mailing address
106 W MOORE AVE, MOORESVILLE, NC 28115-3551
(732) 806-3205
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
08/14/2024
Last updated
04/10/2025
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