NPIMap

Organization Active NPI

October Road, Inc.

  • Community/Behavioral Health Agency
  • Walnut Cove, NC
National Provider Identifier
1992419550
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
522 N Main St
Walnut Cove, NC 27052-9247
Phone
(828) 350-1000
Fax
(828) 350-1300
NPI assigned
Jan 9, 2023
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
Jason Hendricks
Title
Ceo
Phone
(148) 940-0407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

522 N Main St
Walnut Cove, NC 27052-9247

Mailing address

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

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.

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

119 Tunnel Rd
Ste D
Asheville, NC 28805
Phone (888) 201-5086

522 N Main St
Walnut Cove, NC 27052
Phone (336) 753-2655

NPI Registry JSON

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

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1992419550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 TUNNEL RD STE D",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288051800",
            "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": "522 N MAIN ST",
            "city": "WALNUT COVE",
            "state": "NC",
            "postal_code": "270529247",
            "telephone_number": "828-350-1000",
            "fax_number": "828-350-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCTOBER ROAD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-09",
        "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": "CEO",
        "authorized_official_telephone_number": "148-940-0407"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Cove, 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.