Provider Demographics
NPI:1225821457
Name:OUTREACH MINISTRIES INTERNATIONAL
Entity type:Organization
Organization Name:OUTREACH MINISTRIES INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-224-6096
Mailing Address - Street 1:715 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-4827
Mailing Address - Country:US
Mailing Address - Phone:209-224-6096
Mailing Address - Fax:
Practice Address - Street 1:710 N SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-1254
Practice Address - Country:US
Practice Address - Phone:209-642-9684
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?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management