# COASTAL REJUVENATION SOLUTIONS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134801160
- **Authorized official:** LAURA C CRAWFORD MSW (OWNER)
- **Authorized official phone:** (843) 945-1452

## Contact information

- **Practice address:** 630 CHESTNUT RD, MYRTLE BEACH, SC 29572-5502
- **Practice address phone:** (843) 945-1452
- **Practice address fax:** (843) 945-1489
- **Mailing address:** 630 CHESTNUT RD, MYRTLE BEACH, SC 29572-5502
- **Mailing address phone:** (843) 945-1452
- **Mailing address fax:** (843) 945-1489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 163WG0000X | General Practice Registered Nurse | — | NULL | — |
| 163WG0000X | General Practice Registered Nurse | — | — | — |
| 2083B0002X | Obesity Medicine (Preventive Medicine) Physician | — | NULL | — |
| 2083B0002X | Obesity Medicine (Preventive Medicine) Physician | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 261QI0500X | Infusion Therapy Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/01/2023
- **Last updated:** 08/01/2023