Healthcare Provider Details

I. General information

NPI: 1043647084
Provider Name (Legal Business Name): OCTOBER ROAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2013
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 OLD LEICESTER RD
ASHEVILLE NC
28804-9656
US

IV. Provider business mailing address

119 TUNNEL ROAD SUITE D
ASHEVILLE NC
28805
US

V. Phone/Fax

Practice location:
  • Phone: 828-350-1000
  • Fax: 828-350-1300
Mailing address:
  • Phone: 828-350-1000
  • Fax: 828-350-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberNONE HOUSING ONLY
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JASON HENDRICKS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 814-940-0407