Organization
PICKETT GROVE SUPERVISED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CEDRIKA YARNELL HOLLIDAY (PROGRAM DIRECTOR)
(919) 403-9644
Entity
Organization
Contact information
Practice address
3809 PICKETT RD, DURHAM, NC 27705-5331
(919) 403-9644
(919) 489-8489
Mailing address
3809 PICKETT RD, DURHAM, NC 27705-5331
(919) 403-9644
(919) 489-8489
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL 032244
NC
Other
Enumeration date
05/17/2007
Last updated
08/22/2020
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