# PICKETT GROVE SUPERVISED LIVING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669689766
- **Authorized official:** MISS CEDRIKA YARNELL HOLLIDAY (PROGRAM DIRECTOR)
- **Authorized official phone:** (919) 403-9644

## Contact information

- **Practice address:** 3809 PICKETT RD, DURHAM, NC 27705-5331
- **Practice address phone:** (919) 403-9644
- **Practice address fax:** (919) 489-8489
- **Mailing address:** 3809 PICKETT RD, DURHAM, NC 27705-5331
- **Mailing address phone:** (919) 403-9644
- **Mailing address fax:** (919) 489-8489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL 032244 | NC | Yes |

## Other

- **Enumeration date:** 05/17/2007
- **Last updated:** 08/22/2020