Organization
BEACON OF LIFE SC LLC
Active
Other names
BoldAge PACE, BoldAge PACE SC Tri-County Area
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CZERMAK (CHIEF ADMINISTRATIVE OFFICER)
(855) 801-2653
Entity
Organization
Contact information
Practice address
2801 ASHLEY PHOSPHATE RD, NORTH CHARLESTON, SC 29418-4402
(855) 801-2653
(732) 806-3323
Mailing address
106 W MOORE AVE, SUITE A, MOORESVILLE, NC 28115
(732) 806-3205
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
05/17/2023
Last updated
04/10/2025
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