NPIMap

Organization Active NPI

October Road Inc

  • Community/Behavioral Health Agency
  • Jacksonville, NC
National Provider Identifier
1376389940
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
OCTOBER ROAD INC
Practice address
255 Williamsburg Pkwy
Jacksonville, NC 28546-6856
Phone
(828) 606-9013
NPI assigned
Jul 3, 2024
Last updated
Apr 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Jason Hendricks
Title
Ceo
Phone
(814) 940-0407

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

255 Williamsburg Pkwy
Jacksonville, NC 28546-6856

Mailing address

PO Box 967
Duncansville, PA 16635-0967
Phone (814) 940-0407

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
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, NC; Walnut Cove, NC; Mars Hill, NC; Asheville, NC

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2337946October Road Dba Pyramid Jacksonville255 Williamsburg Pkwy Suite a, Jacksonville, NC 28546Certificate of waiverFeb 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
October Road Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5 Oak Branch Dr
Ste E
Greensboro, NC 27407
Phone (336) 398-1392

255 Williamsburg Pkwy
Jacksonville, NC 28546
Phone (828) 606-9013

255 Williamsburg Pkwy
Ste A
Jacksonville, NC 28546
Phone (252) 221-1049

885 Crossroads Pkwy
Ste A2
Mars Hill, NC 28754

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1376389940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 967",
            "city": "DUNCANSVILLE",
            "state": "PA",
            "postal_code": "166350967",
            "telephone_number": "814-940-0407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 WILLIAMSBURG PKWY",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466856",
            "telephone_number": "828-606-9013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCTOBER ROAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-03",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-940-0407"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.