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LAKE SIDE LIVING
NPI 1669317129
In Home Supportive Care in Moorhead, MN

Active since April 21, 2026
1830 40TH AVE S APT 213, MOORHEAD, MN 56560(701) 818-5636 Get Directions Write a Review

NPPES record last updated: April 21, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lake Side Living NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE SIDE LIVING (NPI 1669317129) is a healthcare organization registered as an in home supportive care in Moorhead, Minnesota and active in the NPI registry since April 2026. The organization lists Abdirahim Ismail, Rn, as its authorized official.

NPPES Registry Identity

NPI1669317129
Entity TypeOrganization
Primary Taxonomy253Z00000X
Legal Business NameLAKE SIDE LIVING
Location Address1830 40TH AVE S APT 213Moorhead, MN 56560-7924
Mailing Address1830 40th Ave S Apt 213Moorhead, MN 56560-7924 · (701) 818-5636
Phone(701) 818-5636
Organization SubpartNo
Authorized OfficialAbdirahim IsmailRn · (218) 880-1006
Enumeration DateApril 21, 2026
NPPES CertifiedApril 21, 2026
✔ NPI 1669317129 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIn Home Supportive CareAgencies
Taxonomy Code253Z00000X
Definition
An In Home Supportive Care Agency provides services in the patient's home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves.
1830 40TH AVE S APT 213, Moorhead, MN 56560
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Side Living's NPI number?

The NPI number for Lake Side Living is 1669317129. It was assigned to this organization in the NPPES registry on April 21, 2026.

Where is Lake Side Living located?

Lake Side Living is located at 1830 40th Ave S Apt 213, Moorhead, MN 56560. The listed phone number is (701) 818-5636.

What is Lake Side Living's specialty?

The primary specialty registered for this NPI is In Home Supportive Care with taxonomy code 253Z00000X.

When was this NPI record last updated?

The NPPES record for Lake Side Living was last updated on April 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.