=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720976004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUSTIN ADHC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2025
-----------------------------------------------------
Last Update Date | 07/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14511 FRANKLIN AVE STE 100
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-7213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-419-6243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14511 FRANKLIN AVE STE 100
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-7213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-419-6243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ECHO LU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-419-6243
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------