Provider Demographics
NPI:1033902358
Name:REDEMPTION ETERNAL LLC
Entity type:Organization
Organization Name:REDEMPTION ETERNAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEWAYNE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-631-6995
Mailing Address - Street 1:1213 W MOREHEAD STREET
Mailing Address - Street 2:SUITE 500 UNIT 225
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208
Mailing Address - Country:US
Mailing Address - Phone:305-771-5652
Mailing Address - Fax:
Practice Address - Street 1:1213 W MOREHEAD STREET
Practice Address - Street 2:SUITE 500 UNIT 225
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208
Practice Address - Country:US
Practice Address - Phone:305-771-5652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health