Healthcare Provider Details

I. General information

NPI: 1720976004
Provider Name (Legal Business Name): TUSTIN ADHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14511 FRANKLIN AVE STE 100
TUSTIN CA
92780-7213
US

IV. Provider business mailing address

14511 FRANKLIN AVE STE 100
TUSTIN CA
92780-7213
US

V. Phone/Fax

Practice location:
  • Phone: 949-419-6243
  • Fax:
Mailing address:
  • Phone: 949-419-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ECHO LU
Title or Position: PRESIDENT
Credential:
Phone: 949-419-6243