Healthcare Provider Details

I. General information

NPI: 1174442529
Provider Name (Legal Business Name): MICAH MISSION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W LAUREL AVE
LOMPOC CA
93436-5214
US

IV. Provider business mailing address

921 W LAUREL AVE
LOMPOC CA
93436-5214
US

V. Phone/Fax

Practice location:
  • Phone: 805-260-6724
  • Fax:
Mailing address:
  • Phone: 805-260-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KELSEY BARELA
Title or Position: DIRECTOR OF MINISTRIES
Credential:
Phone: 805-717-1731