Organization
FIVE COUNTY ALCOHOL/DRUP PROGRAM IN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH BOND IV LICDC (EXECUTIVE DIRECTOR)
(419) 782-9920
Entity
Organization
Contact information
Practice address
109 W MAIN ST, ALVORDTON, OH 43501-9763
(419) 924-2029
(419) 924-2061
Mailing address
830 S CLINTON ST, DEFIANCE, OH 43512-2758
(419) 782-9920
(419) 784-2523
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
0559
OH
261QM0850X
Adult Mental Health Clinic/Center
0559
OH
332900000X
Non-Pharmacy Dispensing Site
Primary
0559
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10998
MACSIS UPI
OH
Enumeration date
04/28/2006
Last updated
09/11/2025
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