Healthcare Provider Details

I. General information

NPI: 1376471995
Provider Name (Legal Business Name): THE CHAUN COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4826 GREGORY RD
RIVERSIDE CA
92501-3971
US

IV. Provider business mailing address

4826 GREGORY RD
RIVERSIDE CA
92501-3971
US

V. Phone/Fax

Practice location:
  • Phone: 407-496-7768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: CHANTEL R RUNNELS
Title or Position: OWNER/CEO
Credential:
Phone: 407-496-7768