Healthcare Provider Details

I. General information

NPI: 1609792837
Provider Name (Legal Business Name): TN SAFE HAVEN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 STOCKADE DR
SMYRNA TN
37167-5015
US

IV. Provider business mailing address

434 STOCKADE DR
SMYRNA TN
37167-5015
US

V. Phone/Fax

Practice location:
  • Phone: 615-956-1013
  • Fax:
Mailing address:
  • Phone: 615-267-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES FOGG
Title or Position: OWNER
Credential: JD
Phone: 615-267-3662