NPI 1538991104

Beacon Pace Illinois LLC

Organisation PACE Provider Organization Crestwood, IL

Practice location

Address: 5419 135th St, Crestwood, IL 60418-1529
Phone: (855) 801-2653
Mailing address: 106 W Moore Ave, Mooresville, NC 28115-3551

Authorised official

Name: Michael Czermak
Title: Chief Administrative Officer
Phone: (855) 801-2653

Registered specialties

PACE Provider Organization Primary

Agencies Taxonomy 251T00000X

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Registry record

NPI: 1538991104
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.