NPI 1073345641

Beacon Pace Illinois LLC

Organisation PACE Provider Organization Calumet City, IL

Practice location

Address: 1700 167th St, Calumet City, IL 60409-5458
Phone: (855) 801-2653
Mailing address: 106 W Moore Ave, Mooresville, NC 28115-3551

Authorised official

Name: Micheal Y Czermak
Title: Cao
Phone: (855) 801-2653

Registered specialties

PACE Provider Organization Primary

Agencies Taxonomy 251T00000X

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Registry record

NPI: 1073345641
Entity type: Organization
NPI issued: 14 Aug 2024
Record last updated: 6 Jan 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.