=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982525028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETTY JEANS CREOLE CUISINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26606 COOK FIELD RD STE 300
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-1143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-732-7645
-----------------------------------------------------
Fax | 346-732-7645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20614 IRON TIMBER LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-2394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-732-7645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SHANTE BOUDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-338-8283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332U00000X
-----------------------------------------------------
Taxonomy Name | Home Delivered Meals
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------