Beacon of Life SC LLC

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

BEACON OF LIFE SC LLC

Doing business as

BoldAge PACE SC Tri-County Area

Practice address

2801 Ashley Phosphate Rd
North Charleston, SC 29418-4402

Phone

(855) 801-2653

Fax

(732) 806-3323

NPI assigned

May 17, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Czermak

Title

Chief Administrative Officer

Phone

(855) 801-2653

Specialties & licenses 1

Addresses

Other names 2

• BoldAge PACE SC Tri-County Area Doing business as
• BoldAge PACE Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744243200000",
    "number": "1518658970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W MOORE AVE",
            "address_2": "SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28115",
            "telephone_number": "732-806-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 ASHLEY PHOSPHATE RD",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294184402",
            "telephone_number": "855-801-2653",
            "fax_number": "732-806-3323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON OF LIFE SC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-17",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A",
        "authorized_official_last_name": "CZERMAK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "855-801-2653",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BoldAge PACE SC Tri-County Area",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BoldAge PACE SC Tri-County Area",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BoldAge PACE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Caitlin A Batten, DPT
• Christopher Thomas Battista, MD
• Rebecca Baughan, PT, DPT
• Dodi Lynn Baum, NP-C
• Jeffrey B Bayme, DMD,LLC
• James C Beall, DDS
• Karen Leigh Beatson, RPH
• Beautiful Gate Center
• Megan Elizabeth Bechthold
• Karla Beckwith, R.D.

• PACE Provider Organization in North Charleston, SC
• Providers in North Charleston, SC by specialty
• PACE Provider Organization in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.