Healthcare Provider Details

I. General information

NPI: 1154823466
Provider Name (Legal Business Name): MAGNA'S HAVEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 09/12/2025
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 GATE PARKWAY BLDG 100, SUITE 100
JACKSONVILLE FL
32256
US

IV. Provider business mailing address

5011 GATE PARKWAY BLDG 100 SUITE 100
JACKSONVILLE FL
32256-0830
US

V. Phone/Fax

Practice location:
  • Phone: 305-783-3991
  • Fax: 305-230-7616
Mailing address:
  • Phone: 305-439-6969
  • Fax: 305-230-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13911
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA KUILAN
Title or Position: CEO
Credential: LCSW
Phone: 305-783-3991