Provider Demographics
NPI:1851574503
Name:OCTOBER ROAD, INC.
Entity Type:Organization
Organization Name:OCTOBER ROAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-940-0407
Mailing Address - Street 1:119 TUNNEL RD STE D
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1800
Mailing Address - Country:US
Mailing Address - Phone:828-350-1000
Mailing Address - Fax:828-350-1300
Practice Address - Street 1:885 CROSSROADS PKWY
Practice Address - Street 2:A2
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-9244
Practice Address - Country:US
Practice Address - Phone:828-350-1000
Practice Address - Fax:828-689-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302489PMedicaid
NC8392489QMedicaid
NC8392489QMedicaid