NPIMap

Organization Active NPI

Beacon of Life Central NJ

Doing business as BoldAge PACE Central NJ

  • PACE Provider Organization
  • Oceanport, NJ
National Provider Identifier
1942678396
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
BEACON OF LIFE CENTRAL NJ
Doing business as
BoldAge PACE Central NJ
Practice address
1075 Stephenson Ave
Oceanport, NJ 07757
Phone
(732) 592-3400
NPI assigned
Sep 2, 2015
Last updated
Apr 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X NU Primary

Addresses

Primary practice location

1075 Stephenson Ave
Oceanport, NJ 07757

Mailing address

106 W Moore Ave
Mooresville, NC 28115-3551
Phone (732) 806-3205

Other names 2

  • BoldAge PACE Central NJ Doing business as
  • BoldAge PACE Other name

National Provider Directory

National Provider Directory
Tax ID family
Acutecare Health System LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

106 W Moore Ave
Mooresville, NC 28115

1075 Stephenson Ave
Oceanport, NJ 07757
Phone (732) 592-3400

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1441152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744243200000",
    "number": "1942678396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W MOORE AVE",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281153551",
            "telephone_number": "732-806-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 STEPHENSON AVE",
            "city": "OCEANPORT",
            "state": "NJ",
            "postal_code": "07757",
            "telephone_number": "732-592-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON OF LIFE CENTRAL NJ",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-02",
        "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"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BoldAge PACE Central NJ",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BoldAge PACE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oceanport, NJ

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.