Provider Demographics
NPI:1093289134
Name:HELPING OUR YOUTH ACHIEVE CASE MANAGEMENT
Entity Type:Organization
Organization Name:HELPING OUR YOUTH ACHIEVE CASE MANAGEMENT
Other - Org Name:HOYA
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:443-435-4771
Mailing Address - Street 1:5525 BELAIR RD STE B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-3654
Mailing Address - Country:US
Mailing Address - Phone:443-435-4771
Mailing Address - Fax:
Practice Address - Street 1:5525 BELAIR RD STE B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-3654
Practice Address - Country:US
Practice Address - Phone:443-435-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOYA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1477064251Medicaid