Provider Demographics
NPI:1255139093
Name:HAVEN HOME MEDICAL GROUP LLC
Entity type:Organization
Organization Name:HAVEN HOME MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASCHKKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-979-9453
Mailing Address - Street 1:4632 SPARTA HWY
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-5158
Mailing Address - Country:US
Mailing Address - Phone:615-979-9453
Mailing Address - Fax:
Practice Address - Street 1:118 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1326
Practice Address - Country:US
Practice Address - Phone:615-979-9453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty