WM. W. FOX DEVELOPMENTAL CENTER 1C (NPI# 1629112503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629112503 |
| Entity Type | Organization |
| Organization Name | WM. W. FOX DEVELOPMENTAL CENTER 1C |
| Practice Address |
134 W Main St Dwight IL 60420-1322 |
| Practice Telephone | 8155843347 |
| Mailing Telephone | 8155843347 |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. GUS PEDRAZA (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8155843347 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
134 W MAIN ST |
| City | DWIGHT |
| State | IL |
| Zip Code | 60420-1322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932243920 | Wm. W. Fox Developmental Center 3a | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1972647808 | Wm. W. Fox Developmental Center 1b | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1811031818 | Wm. W. Fox Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1720122724 | Wm. W. Fox Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1639213630 | Wm. W. Fox Developmental Center 3c | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1063556066 | Wm. W. Fox Developmental Center 3b | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1710021696 | Wm. W. Fox Developmental Center 2c | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1841330693 | Suresh Vade | Family Medicine | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-08 |
| 1063566891 | Wm. W. Fox Developmental Center | Pharmacy | 134 W Main St, Dwight, IL 60420-1322 | 2007-01-22 |
| 1265584155 | Illinois Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-01-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902149982 | Maulin G Shah | Family Medicine | 107 Watters Dr, Dwight, IL 60420 | 2013-03-28 |
| 1558446633 | Highland Park Cvs, L.l.c | Durable Medical Equipment & Medical Supplies | 106 Watters Dr, Dwight, IL 60420 | 2006-10-26 |
| 1861598997 | Cynthia Ann Humbert | Dentist | 413 E Mazon Ave, Dwight, IL 60420 | 2006-09-16 |
| 1851404313 | Mark A Passerman | Family Medicine | 101 S Prairie Ave, Dwight, IL 60420 | 2006-08-17 |
| 1528174489 | Bradford R Egly | Podiatrist | 108 W Main St, Dwight, IL 60420 | 2006-08-22 |
| 1558820829 | Laura E Lamere | Occupational Therapy Assistant | 215 E North St, Dwight, IL 60420-1051 | 2019-03-17 |
| 1982695029 | Heritage Manor Dwight, LLC | Durable Medical Equipment & Medical Supplies | 300 E Mazon Ave, Dwight, IL 60420-1104 | 2005-10-28 |
| 1194280024 | Matthew J Govednik | Physical Therapy Assistant | 300 E Mazon Ave, Dwight, IL 60420-1104 | 2019-02-05 |
| 1215346036 | Kelly Martin | Occupational Therapist | 300 E Mazon Ave, Dwight, IL 60420-1104 | 2014-08-06 |
| 1487061974 | Debra Wilder | Physical Therapy Assistant | 300 E Mazon Ave, Dwight, IL 60420-1104 | 2014-07-16 |
| Find all providers in zip 60420 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932243920 | Wm. W. Fox Developmental Center 3a | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1972647808 | Wm. W. Fox Developmental Center 1b | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1811031818 | Wm. W. Fox Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1720122724 | Wm. W. Fox Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1639213630 | Wm. W. Fox Developmental Center 3c | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1063556066 | Wm. W. Fox Developmental Center 3b | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1710021696 | Wm. W. Fox Developmental Center 2c | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1265584155 | Illinois Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689218273 | Dymond Homes LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4223 S Prairie Ave, Chicago, IL 60653-3211 | 2019-11-06 |
| 1447782396 | Light of Hope | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 22858 Millard Ave, Richton Park, IL 60471-2531 | 2017-03-30 |
| 1760831945 | Nucare Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18118 Orleans Dr, Hazel Crest, IL 60429-2242 | 2016-06-08 |
| 1649629346 | Catina Ballin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 8808 Riley Road, Wonderlake, IL 60097 | 2016-06-03 |
| 1003262254 | Patterson House Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 717 E 1st South St, Carlinville, IL 62626-1922 | 2016-05-06 |
| 1235592288 | Ray Graham Association | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 901 Warrenville Rd, Suite 500, Lisle, IL 60532-4301 | 2016-03-29 |
| 1962867796 | Pioneer Center for Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1315 N Curran Rd, Mchenry, IL 60050-6520 | 2015-12-21 |
| 1942675228 | Pioneer Center for Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 701 N Hart St, Harvard, IL 60033-2227 | 2015-12-11 |
| 1518332881 | Pioneer Center for Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 851 W Main St, Cary, IL 60013-1920 | 2015-12-11 |
| 1083089361 | Pioneer Center for Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 455 Huntley Rd, Crystal Lake, IL 60014-5318 | 2015-12-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.