Provider Demographics
NPI:1063244630
Name:BEACON OF LIFE NORTH NJ LLC
Entity type:Organization
Organization Name:BEACON OF LIFE NORTH NJ LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CZERMAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-801-2653
Mailing Address - Street 1:106 W MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3551
Mailing Address - Country:US
Mailing Address - Phone:732-806-3205
Mailing Address - Fax:
Practice Address - Street 1:25 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:E BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1259
Practice Address - Country:US
Practice Address - Phone:732-806-3205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization