NPIMap

Organization Active NPI

October Road Inc.

  • Community/Behavioral Health Agency
  • Asheville, NC
National Provider Identifier
1144375767
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
OCTOBER ROAD INC.
Practice address
119 Tunnel Rd Ste B
Asheville, NC 28805-1800
Phone
(828) 350-1000
Fax
(828) 350-1300
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jason Hendricks
Title
Chief Executive Officer
Phone
(814) 940-0407

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X MLH-011-272 NC
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

119 Tunnel Rd Ste B
Asheville, NC 28805-1800

Mailing address

119 Tunnel Rd
Suite D
Asheville, NC 28805-1869
Phone (828) 350-1000

Other practice location 1

119 Tunnel Rd
Suite B & D
Asheville, NC 28805-1800
Phone (828) 350-1000

Other identifiers 6

IdentifierTypeStateIssuer
MHL-011-272OtherNC DHSR
5905845MedicaidNC
6006159MedicaidNC
8703016MedicaidNC
3410004MedicaidNC
8305312MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090501000491 NC Part B Supplier - Clinic/Group Practice 3577611433 Receives reassigned benefits from 26 practitioners
4 other NPIs on this enrollment
Practice locations: Jacksonville, NC; Walnut Cove, NC; Mars Hill, NC; Asheville, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1144375767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 TUNNEL RD",
            "address_2": "SUITE D",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288051869",
            "telephone_number": "828-350-1000",
            "fax_number": "828-350-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 TUNNEL RD STE B",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288051800",
            "telephone_number": "828-350-1000",
            "fax_number": "828-350-1300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 Tunnel Rd",
            "address_2": "Suite B & D",
            "address_purpose": "LOCATION",
            "city": "Asheville",
            "state": "NC",
            "postal_code": "288051800",
            "country_code": "US",
            "telephone_number": "828-350-1000",
            "fax_number": "828-350-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OCTOBER ROAD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "814-940-0407",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "MLH-011-272",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC DHSR",
            "identifier": "MHL-011-272",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905845",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006159",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8703016",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3410004",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8305312",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Asheville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.