Healthcare Provider Details

I. General information

NPI: 1700796752
Provider Name (Legal Business Name): SEED AND SHELTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 E MAIN ST
BARSTOW CA
92311-5870
US

IV. Provider business mailing address

2346 E MAIN ST
BARSTOW CA
92311-5870
US

V. Phone/Fax

Practice location:
  • Phone: 619-972-9633
  • Fax:
Mailing address:
  • Phone: 619-972-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN EDGAR CORRAL
Title or Position: PRESIDENT
Credential:
Phone: 619-972-9633