Organization
BEACON PACE ILLINOIS LLC
Active
Other names
BoldAge PACE Illinois
Organization subpart
No
Provider details
NPI number
Authorized official
MICHEAL Y CZERMAK (CAO)
(855) 801-2653
Entity
Organization
Contact information
Practice address
1700 167TH ST, CALUMET CITY, IL 60409-5458
(855) 801-2653
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
01/06/2026
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