PICKETT GROVE SUPERVISED LIVING NPI 1669689766

NPI Information

PICKETT GROVE SUPERVISED LIVING is a residential treatment facility, intellectual and/or developmental disabilities in Durham, NC. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. PICKETT GROVE SUPERVISED LIVING NPI is 1669689766. The provider is registered as an organization entity type.

The provider's business location address is:

3809 PICKETT RD
DURHAM, NC
ZIP 27705-331
Phone: (919) 403-9644
Fax: (919) 489-8489

The provider's authorized official is Cedrika Yarnell Holliday .
The authorized official title is Program Director and has the following contact phone number (919) 403-9644.

The enumeration date for this NPI number is 5/17/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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