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General NPI Number Information
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NPI Number | 1093772386
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Entity Type | Organization
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Legal Business Name | FIVE COUNTY ALCOHOL/DRUP PROGRAM IN
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 109 W MAIN ST
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City | ALVORDTON
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State | OH
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Zip | 43501-9763
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Country | US
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Telephone | 419-924-2029
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Fax | 419-924-2061
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Provider Business Mailing Address
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Address Line | 830 S CLINTON ST
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City | DEFIANCE
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State | OH
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Zip | 43512-2758
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Country | US
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Telephone | 419-782-9920
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Fax | 419-784-2523
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KENNETH BOND IV
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Credential | LICDC
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Telephone | 419-782-9920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0559
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0559
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 0559
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License Number State | OH
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