=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710352448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASS GROUP USA, INC. BY & THROUGH ITS BATEMAN DIVISION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2015
-----------------------------------------------------
Last Update Date | 12/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3155 W PINHOOK RD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-3445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-234-8849
-----------------------------------------------------
Fax | 337-235-6049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3110 W PINHOOK RD STE 201
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-3453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-593-0433
-----------------------------------------------------
Fax | 225-208-1504
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL VICE PRESIDENT
-----------------------------------------------------
Name | MAGI BRETTLER
-----------------------------------------------------
Credential | FMP FOOD MGMT PROFES
-----------------------------------------------------
Telephone | 337-593-0433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332U00000X
-----------------------------------------------------
Taxonomy Name | Home Delivered Meals
-----------------------------------------------------
License Number | 5256706-001
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------