Provider Demographics
NPI:1164447017
Name:PROFESSIONAL PRODUCTIONS
Entity Type:Organization
Organization Name:PROFESSIONAL PRODUCTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-591-1820
Mailing Address - Street 1:PO BOX 3548
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3548
Mailing Address - Country:US
Mailing Address - Phone:803-252-6610
Mailing Address - Fax:
Practice Address - Street 1:1800 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2433
Practice Address - Country:US
Practice Address - Phone:866-591-1820
Practice Address - Fax:866-591-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251C00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX3033Medicaid