MEDICARE: AGENTIC CLIENT SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	376J00000X	Homemaker
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	3747P1801X	Personal Care Attendant
4	172A00000X	Driver
5	343900000X	Non-emergency Medical Transport (VAN)
6	347C00000X	Private Vehicle
7	372600000X	Adult Companion
8	251X00000X	Supports Brokerage Agency
9	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2573689	OTHER	OH	OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES

General Provider Information

NPI Number	:	1033789177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGENTIC CLIENT SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	6281 MARSH WREN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-6533
Country	:	US
Telephone Number	:	614-907-6782
Fax Number	:

Provider Business Practice Location Address
First Line	:	6281 MARSH WREN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-6533
Country	:	US
Telephone Number	:	614-907-6782
Fax Number	:

Authorized Official
Title or Position	:	AGENCY CEO
Name	:	KURTIS MCLENDON
Credential	:
Telephone Number	:	419-961-5104

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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Directions to “AGENTIC CLIENT SUPPORT SERVICES LLC ” Practice Location

Language	Start Address	Practice Location

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