Healthcare Provider Details

I. General information

NPI: 1750902250
Provider Name (Legal Business Name): REDEFINED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6432 E MAIN ST STE 101
REYNOLDSBURG OH
43068-2368
US

IV. Provider business mailing address

PO BOX 182
PICKERINGTON OH
43147-0182
US

V. Phone/Fax

Practice location:
  • Phone: 614-655-4300
  • Fax:
Mailing address:
  • Phone: 614-655-4300
  • Fax: 614-695-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSE SANDERS
Title or Position: PRESIDENT
Credential: PHD
Phone: 614-655-4300