Coastal Rejuvenation Solutions

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

COASTAL REJUVENATION SOLUTIONS

Practice address

630 Chestnut Rd
Myrtle Beach, SC 29572-5502

Phone

(843) 945-1452

Fax

(843) 945-1489

NPI assigned

Aug 1, 2023

Organization subpart

No

Name

Laura C Crawford, MSW

Title

Owner

Phone

(843) 945-1452

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laura L Crawford, LISW-CP

  • Clinical Social Worker
  • Myrtle Beach, SC
  • NPI 1023604600

  Social Worker

  NPD

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 1, 2023.

{
    "created_epoch": "1690848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1134801160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 CHESTNUT RD",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295725502",
            "telephone_number": "843-945-1452",
            "fax_number": "843-945-1489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 CHESTNUT RD",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295725502",
            "telephone_number": "843-945-1452",
            "fax_number": "843-945-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL REJUVENATION SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-01",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-945-1452",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083B0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Coastal Wellness Center, LLC

• All providers in Myrtle Beach, SC
• Multi-Specialty Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.