Organization
BOLDAGE PACE KENTUCKY LLC
Active
Parent organization
BOLDAGE PACE, LLC
Other names
BoldAge PACE
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOLDAGE PACE, LLC
Authorized official
MICHEAL Y CZERMAK (CHIEF ADMINISTRATIVE OFFICER)
(855) 801-2653
Entity
Organization
Contact information
Practice address
2050 E PARRISH AVE, OWENSBORO, KY 42303-1448
(732) 806-3205
Mailing address
112 EXMORE ROAD, SUITE 3, MOORESVILLE, NC 28117
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
05/17/2023
Last updated
05/28/2026
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