Healthcare Provider Details

I. General information

NPI: 1376408609
Provider Name (Legal Business Name): MOTHER SHIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 S COMMERCIAL AVE
EAGLE GROVE IA
50533-2210
US

IV. Provider business mailing address

322 S COMMERCIAL AVE
EAGLE GROVE IA
50533-2210
US

V. Phone/Fax

Practice location:
  • Phone: 515-448-4852
  • Fax: 515-448-3533
Mailing address:
  • Phone: 515-448-4852
  • Fax: 515-448-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MOFFITT
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 515-448-4852