Provider Demographics
NPI:1053002923
Name:BATES, JEROME
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SOMERVELLE ST APT 410
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-8651
Mailing Address - Country:US
Mailing Address - Phone:301-385-3071
Mailing Address - Fax:
Practice Address - Street 1:920 BELLEVUE ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-6030
Practice Address - Country:US
Practice Address - Phone:202-562-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility