Organization
BOLDAGE PACE KENTUCKY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CZERMAK (CHIEF ADMINISTRATIVE OFFICER)
(732) 806-3205
Entity
Organization
Contact information
Practice address
2050 E PARRISH AVE, OWENSBORO, KY 42303-1448
(732) 806-3205
Mailing address
106 W MOORE AVE STE A, MOORESVILLE, NC 28115-3552
(732) 806-3223
(732) 806-3323
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
05/17/2023
Last updated
08/14/2024
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