Provider Demographics
NPI:1336805266
Name:SLAUGHTER, RODNEY D SR
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:D
Last Name:SLAUGHTER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 TRUMBULL AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4578
Mailing Address - Country:US
Mailing Address - Phone:330-261-7428
Mailing Address - Fax:
Practice Address - Street 1:1192 TRUMBULL AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4578
Practice Address - Country:US
Practice Address - Phone:330-261-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator