Healthcare Provider Details

I. General information

NPI: 1124995386
Provider Name (Legal Business Name): MEN'S LUXURY SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 E COLONIAL DR STE 101
ORLANDO FL
32803-4726
US

IV. Provider business mailing address

1516 E COLONIAL DR STE 101
ORLANDO FL
32803-4726
US

V. Phone/Fax

Practice location:
  • Phone: 321-247-5553
  • Fax:
Mailing address:
  • Phone: 321-247-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC RICHARDSON RICHARDSON
Title or Position: CEO
Credential:
Phone: 407-885-9633