MEDICARE: OAK SHADOWS OF JENNINGS, LLC

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	251G00000X	Community Based Hospice Care Agency	139	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	190031148Z	OTHER	LA	BLUE CROSS BLUE SHIELD OF

General Provider Information

NPI Number	:	1750399382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK SHADOWS OF JENNINGS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-233-5764

Provider Business Practice Location Address
First Line	:	1322 ELTON RD
Second Line	:	SUITE G
City	:	JENNINGS
State	:	LA
Zip	:	70546-4100
Country	:	US
Telephone Number	:	337-616-3482
Fax Number	:	337-616-9399

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD D. STELLY
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	04/26/2017

Similar Medicare Providers

1316929813 — DR. LAM DUY NGUYEN M.D.
Practice Location Address:

1322 ELTON RD STE E
JENNINGS, LA
70546-4100

Practice Phone: 337-824-6835
Practice Fax: 337-824-8741

1669403697 — HEALTH MART OF JENNINGS LLC
Practice Location Address:

1322 ELTON RD , SUITE A
JENNINGS, LA
70546-4100

Practice Phone: 337-616-9500
Practice Fax: 337-616-9555

1558455733 — BRIAN CRANFORD WILDER M.D.
Practice Location Address:

1322 ELTON RD , SUITE H
JENNINGS, LA
70546-4100

Practice Phone: 337-246-7200
Practice Fax: 337-246-7202

1548394489 — DR. JOEL HARRIS CONNER D.C.
Practice Location Address:

1322 ELTON RD
JENNINGS, LA
70546-4100

Practice Phone: 337-329-3352
Practice Fax: 337-824-8892

1679754162 — ALLISON P BOULET MPT
Practice Location Address:

1322 ELTON RD , SUITE I
JENNINGS, LA
70546-4100

Practice Phone: 337-824-5488
Practice Fax: 337-824-5494

1477722486 — ANGELA P SOILEAU OT
Practice Location Address:

1322 ELTON RD , SUITE I
JENNINGS, LA
70546-4100

Practice Phone: 337-824-5488
Practice Fax: 337-824-5494

Directions to “OAK SHADOWS OF JENNINGS, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.