Provider Demographics
NPI:1972356723
Name:HOYA MARYLAND LLC
Entity Type:Organization
Organization Name:HOYA MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:443-435-4771
Mailing Address - Street 1:1120 N CHARLES ST STE 415
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5500
Mailing Address - Country:US
Mailing Address - Phone:443-435-4771
Mailing Address - Fax:
Practice Address - Street 1:1120 N CHARLES ST STE 415
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5500
Practice Address - Country:US
Practice Address - Phone:443-435-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HELPING OUR YOUTH ACHIEVE PSYCHIATRIC REHABILITATION PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD19012772Medicaid