Provider Demographics
NPI:1063566891
Name:WM. W. FOX DEVELOPMENTAL CENTER
Entity type:Organization
Organization Name:WM. W. FOX DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:779-249-6231
Mailing Address - Street 1:134 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DWIGHT
Mailing Address - State:IL
Mailing Address - Zip Code:60420-1322
Mailing Address - Country:US
Mailing Address - Phone:779-249-6231
Mailing Address - Fax:815-584-3723
Practice Address - Street 1:134 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-1322
Practice Address - Country:US
Practice Address - Phone:815-584-3347
Practice Address - Fax:815-584-3723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILLINOIS DEPARTMENT OF HUMAN SEVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
IL059-006196282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy