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General NPI Number Information
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NPI Number | 1750902250
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Entity Type | Organization
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Legal Business Name | REDEFINED LLC
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1561 OLD LEONARD AVE
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City | COLUMBUS
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State | OH
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Zip | 43219-2580
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Country | US
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Telephone | 614-655-4300
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Fax | 614-695-5300
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Provider Business Mailing Address
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Address Line | PO BOX 182
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City | PICKERINGTON
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State | OH
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Zip | 43147-0182
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Country | US
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Telephone | 614-655-4300
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Fax | 614-695-5300
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSE SANDERS
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Credential | PHD
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Telephone | 614-655-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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