MEDICARE: BATES PLACE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1487994422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BATES PLACE INC

Provider Business Mailing Address
First Line	:	623 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-3021
Country	:	US
Telephone Number	:	361-552-0195
Fax Number	:	361-552-0195

Provider Business Practice Location Address
First Line	:	623 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-3021
Country	:	US
Telephone Number	:	361-552-0195
Fax Number	:	361-552-0195

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. KAREN LOU ANN BATES
Credential	:	SLP
Telephone Number	:	361-552-0195

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	02/28/2013

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Directions to “BATES PLACE INC ” Practice Location

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