Healthcare Provider Details

I. General information

NPI: 1992419550
Provider Name (Legal Business Name): OCTOBER ROAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N MAIN ST
WALNUT COVE NC
27052-9247
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: 828-350-1300
Mailing address:
  • Phone: 828-350-1000
  • Fax: 828-350-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JASON HENDRICKS
Title or Position: CEO
Credential:
Phone: 148-940-0407