Provider Demographics
NPI:1346615135
Name:COMPASS GROUP USA, INC. BY & THROUGH ITS BATEMAN DIVISION
Entity Type:Organization
Organization Name:COMPASS GROUP USA, INC. BY & THROUGH ITS BATEMAN DIVISION
Other - Org Name:BATEMAN COMMUNITY LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:FMP FOOD MGMT PROFES
Authorized Official - Phone:337-593-0433
Mailing Address - Street 1:3110 W PINHOOK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3453
Mailing Address - Country:US
Mailing Address - Phone:337-593-0433
Mailing Address - Fax:225-208-1504
Practice Address - Street 1:1034 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4325
Practice Address - Country:US
Practice Address - Phone:814-724-3917
Practice Address - Fax:814-724-3917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASS ONE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-06
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA113421332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1801261722Medicaid
CA1386068500Medicaid