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General NPI Number Information
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NPI Number | 1750399382
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Entity Type | Organization
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Legal Business Name | OAK SHADOWS OF JENNINGS, LLC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 1322 ELTON RD SUITE G
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City | JENNINGS
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State | LA
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Zip | 70546-4100
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Country | US
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Telephone | 337-616-3482
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Fax | 337-616-9399
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax | 337-233-5764
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DONALD D. STELLY
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Credential |
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Telephone | 337-233-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 139
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License Number State | LA
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