Provider Demographics
NPI:1700623345
Name:MONARCH MOTHERHOOD LLC
Entity type:Organization
Organization Name:MONARCH MOTHERHOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLOVER
Authorized Official - Middle Name:
Authorized Official - Last Name:SISAMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-554-1468
Mailing Address - Street 1:PO BOX 71602
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-0602
Mailing Address - Country:US
Mailing Address - Phone:515-243-2057
Mailing Address - Fax:
Practice Address - Street 1:10888 HICKMAN RD STE 3B
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-3715
Practice Address - Country:US
Practice Address - Phone:515-243-2057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies