Lake Side Living

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

LAKE SIDE LIVING

Practice address

1830 40TH Ave S Apt 213
Moorhead, MN 56560-7924

Phone

(701) 818-5636

NPI assigned

Apr 21, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abdirahim Ismail, ISMAIL

Title

RN

Phone

(218) 880-1006

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776729600000",
    "number": "1669317129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 40TH AVE S APT 213",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565607924",
            "telephone_number": "701-818-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 40TH AVE S APT 213",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565607924",
            "telephone_number": "701-818-5636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SIDE LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-21",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "ABDIRAHIM",
        "authorized_official_title_or_position": "RN",
        "authorized_official_telephone_number": "218-880-1006",
        "authorized_official_credential": "ISMAIL"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colette Clarice Kuznia, MED MASTERS DEGREE I
• Tanner Kuznia, DC
• Kelsey K Labodi, ATC
• Miranda Irene Lacanne
• Leane Marie Lafrance, LADC, ADCR-MN
• Rita Lall, LICENSED PSYCHOLOGIS
• Jacqueline Landis
• Amanda Lane, PSYD
• Britni Kay Langevin, LPCC
• Rhian Larocque

• In Home Supportive Care Agency in Moorhead, MN
• Providers in Moorhead, MN by specialty
• In Home Supportive Care Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.