Healthcare Provider Details

I. General information

NPI: 1730909821
Provider Name (Legal Business Name): ML FUND1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 BONNER AVE
AURORA IL
60505-3837
US

IV. Provider business mailing address

3015 E NEW YORK ST # A2112
AURORA IL
60504-5162
US

V. Phone/Fax

Practice location:
  • Phone: 331-701-9836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERICA LAWSON
Title or Position: CEO
Credential:
Phone: 331-701-9836