# LAKE SIDE LIVING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669317129
- **Authorized official:** ABDIRAHIM ISMAIL ISMAIL (RN)
- **Authorized official phone:** (218) 880-1006

## Contact information

- **Practice address:** 1830 40TH AVE S APT 213, MOORHEAD, MN 56560-7924
- **Practice address phone:** (701) 818-5636
- **Mailing address:** 1830 40TH AVE S APT 213, MOORHEAD, MN 56560-7924
- **Mailing address phone:** (701) 818-5636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/21/2026
- **Last updated:** 04/21/2026