MEDICARE: OCTOBER ROAD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1346074481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCTOBER ROAD INC

Provider Business Mailing Address
First Line	:	PO BOX 967
Second Line	:
City	:	DUNCANSVILLE
State	:	PA
Zip	:	16635-0967
Country	:	US
Telephone Number	:	814-940-0407
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 ZION CHURCH RD E
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-6827
Country	:	US
Telephone Number	:	724-996-2744
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JASON HENDRICKS
Credential	:
Telephone Number	:	814-940-0407

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	01/21/2026

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Directions to “OCTOBER ROAD INC ” Practice Location

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