Provider Demographics
NPI:1033789177
Name:AGENTIC CLIENT SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:AGENTIC CLIENT SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-961-5104
Mailing Address - Street 1:6281 MARSH WREN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6533
Mailing Address - Country:US
Mailing Address - Phone:614-907-6782
Mailing Address - Fax:
Practice Address - Street 1:6281 MARSH WREN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6533
Practice Address - Country:US
Practice Address - Phone:614-907-6782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No251X00000XAgenciesSupports BrokerageGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444477Medicaid
OH2573689OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES