Provider Demographics
NPI:1154823466
Name:MAGNA'S HAVEN, INC.
Entity Type:Organization
Organization Name:MAGNA'S HAVEN, INC.
Other - Org Name:JESSICA KUILAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUILAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-783-3991
Mailing Address - Street 1:5011 GATE PARKWAY BLDG 100 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0830
Mailing Address - Country:US
Mailing Address - Phone:305-439-6969
Mailing Address - Fax:305-230-7616
Practice Address - Street 1:5011 GATE PARKWAY
Practice Address - Street 2:BLDG 100, SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:305-783-3991
Practice Address - Fax:305-230-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW139111041C0700X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty