Healthcare Provider Details

I. General information

NPI: 1164447017
Provider Name (Legal Business Name): PROFESSIONAL PRODUCTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MAIN ST STE 100
COLUMBIA SC
29201-2433
US

IV. Provider business mailing address

PO BOX 3548
COLUMBIA SC
29230-3548
US

V. Phone/Fax

Practice location:
  • Phone: 866-591-1820
  • Fax: 866-591-1820
Mailing address:
  • Phone: 803-252-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES L AIKEN
Title or Position: MANAGER
Credential:
Phone: 866-591-1820