Provider Demographics
NPI:1326641044
Name:OCTOBER ENTERPRISES, INC.
Entity Type:Organization
Organization Name:OCTOBER ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCHWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-293-7703
Mailing Address - Street 1:501 W LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9274
Mailing Address - Country:US
Mailing Address - Phone:937-456-9535
Mailing Address - Fax:937-456-9530
Practice Address - Street 1:501 W LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9274
Practice Address - Country:US
Practice Address - Phone:937-456-9535
Practice Address - Fax:937-456-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0860091Medicaid