Healthcare Provider Details

I. General information

NPI: 1285432047
Provider Name (Legal Business Name): OCTOBER ROAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110A MACON CENTER DR
FRANKLIN NC
28734-7020
US

IV. Provider business mailing address

PO BOX 967
DUNCANSVILLE PA
16635-0967
US

V. Phone/Fax

Practice location:
  • Phone: 814-940-0407
  • Fax:
Mailing address:
  • Phone: 814-940-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON HENDRICKS
Title or Position: CEO
Credential:
Phone: 814-940-0407