Provider Demographics
NPI:1609501428
Name:MAGDAN LLC
Entity Type:Organization
Organization Name:MAGDAN LLC
Other - Org Name:ZION HEALING CENTER FORT MYERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCHUGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-372-6141
Mailing Address - Street 1:9405 CYPRESS LAKE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0909
Mailing Address - Country:US
Mailing Address - Phone:239-946-6538
Mailing Address - Fax:
Practice Address - Street 1:9405 CYPRESS LAKE DR STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-0909
Practice Address - Country:US
Practice Address - Phone:239-372-6141
Practice Address - Fax:239-936-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder