MEDICARE: NORTHWESTERN LIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1376495358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWESTERN LIVING LLC

Provider Business Mailing Address
First Line	:	601 CARLSON PKWY STE 1045
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55305-5203
Country	:	US
Telephone Number	:	612-450-1096
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 S LOUISE AVE STE 203C
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3143
Country	:	US
Telephone Number	:	612-450-1096
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAMAL MOHAMED JAMA
Credential	:
Telephone Number	:	612-450-1096

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “NORTHWESTERN LIVING LLC ” Practice Location

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