Organization
BEACON PACE ILLINOIS LLC
Active
Other names
BoldAge PACE Illinois
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CZERMAK (CHIEF ADMINISTRATIVE OFFICER)
(855) 801-2653
Entity
Organization
Contact information
Practice address
5419 135TH ST, CRESTWOOD, IL 60418-1529
(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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