Organization
FIVE COUNTY ALCOHOL/DRUG PROGRAM SERENITY HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH BOND LICDC (EXECUTIVE DIRECTOR)
(419) 782-9920
Entity
Organization
Contact information
Practice address
25212 US ROUTE 20, FAYETTE, OH 43521-9511
(419) 237-3103
(419) 237-4044
Mailing address
830 S CLINTON ST, DEFIANCE, OH 43512-2758
(419) 782-9920
(419) 784-2523
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
7111
OH
261Q00000X
Clinic/Center
Primary
7111
OH
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
7111
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07111
MACSIS UPI
OH
Enumeration date
04/28/2006
Last updated
09/11/2025
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