Healthcare Provider Details

I. General information

NPI: 1194642983
Provider Name (Legal Business Name): GREGORY BALDWIN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E BUTTERFIELD RD STE 300
LOMBARD IL
60148
US

IV. Provider business mailing address

700 E BUTTERFIELD RD STE 300
LOMBARD IL
60148
US

V. Phone/Fax

Practice location:
  • Phone: 708-640-5025
  • Fax:
Mailing address:
  • Phone: 708-640-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHF136517
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: