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SOUTHERN LIGHT RESIDENTIAL
NPI 1801312459
Counselor - Professional in Bolivar, MO

Active since August 16, 2017
1211 E BROADWAY ST, BOLIVAR, MO 65613(417) 850-4555(417) 777-7017 Get Directions Write a Review

NPPES record last updated: August 16, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southern Light Residential NPPES

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

SOUTHERN LIGHT RESIDENTIAL (NPI 1801312459) is a healthcare organization registered as a professional in Bolivar, Missouri and active in the NPI registry since August 2017. The organization lists Cindy Drake, Admin Director, as its authorized official.

NPPES Registry Identity

NPI1801312459
Entity TypeOrganization
Primary Taxonomy101YP2500X
Legal Business NameSOUTHERN LIGHT RESIDENTIAL
Location Address1211 E BROADWAY STBolivar, MO 65613-2952
Mailing Address707 S Pearl AveJoplin, MO 64801-4334 · (417) 850-4555 · Fax (417) 777-7017
Phone(417) 850-4555
Fax(417) 777-7017
Organization SubpartNo
Authorized OfficialCindy DrakeAdmin Director · (417) 850-4555
Enumeration DateAugust 16, 2017
✔ NPI 1801312459 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
1211 E BROADWAY ST, Bolivar, MO 65613
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HOME COURT ADVANTAGE, INC.
Psychiatric Residential Treatment Facility
1211 E BROADWAY ST
BOLIVAR, MO 65613
Polk County (417) 777-6980
HOME COURT ADVANTAGE V
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
1211 E BROADWAY ST
BOLIVAR, MO 65613
Polk County (417) 777-6980
HOME COURT ADVANTAGE, INC.
Psychiatric Residential Treatment Facility
1211 E BROADWAY ST
BOLIVAR, MO 65613
Polk County (417) 777-6980
HOME COURT ADVANTAGE, INC.
Psychiatric Residential Treatment Facility
1211 E BROADWAY ST
BOLIVAR, MO 65613
Polk County (417) 777-6980

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 Southern Light Residential's NPI number?

The NPI number for Southern Light Residential is 1801312459. It was assigned to this organization in the NPPES registry on August 16, 2017.

Where is Southern Light Residential located?

Southern Light Residential is located at 1211 E Broadway St, Bolivar, MO 65613. The listed phone number is (417) 850-4555.

What is Southern Light Residential's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

When was this NPI record last updated?

The NPPES record for Southern Light Residential was last updated on August 16, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years 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.