Healthcare Provider Details

I. General information

NPI: 1851574503
Provider Name (Legal Business Name): OCTOBER ROAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 CROSSROADS PKWY A2
MARS HILL NC
28754-9244
US

IV. Provider business mailing address

119 TUNNEL RD STE D
ASHEVILLE NC
28805-1800
US

V. Phone/Fax

Practice location:
  • Phone: 828-350-1000
  • Fax: 828-689-3997
Mailing address:
  • Phone: 828-350-1000
  • Fax: 828-350-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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