Healthcare Provider Details

I. General information

NPI: 1801689252
Provider Name (Legal Business Name): FIFTY SEVEN CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PASEO REYES DR FL 32095
ST AUGUSTINE FL
32095-8464
US

IV. Provider business mailing address

350 PASEO REYES DR FL 32095
ST AUGUSTINE FL
32095-8464
US

V. Phone/Fax

Practice location:
  • Phone: 904-352-2944
  • Fax:
Mailing address:
  • Phone: 904-352-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALAN HENDERSON
Title or Position: OWNER
Credential:
Phone: 617-347-9480