Provider Demographics
NPI:1649781139
Name:LIGHTNER, ARETHA DENISE (ADMINISTRATOR)
Entity type:Individual
Prefix:MRS
First Name:ARETHA
Middle Name:DENISE
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 W LUMBER ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-8363
Mailing Address - Country:US
Mailing Address - Phone:661-547-4238
Mailing Address - Fax:
Practice Address - Street 1:3024 W LUMBER ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-8363
Practice Address - Country:US
Practice Address - Phone:661-547-4238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6027587730376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator