Provider Demographics
NPI:1720836570
Name:PREVENTION GAMBLER FOUNDATION
Entity Type:Organization
Organization Name:PREVENTION GAMBLER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:GAMBLING COUNSELOR
Authorized Official - Phone:954-860-3216
Mailing Address - Street 1:1027 S RAINBOW BLVD STE 162
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6232
Mailing Address - Country:US
Mailing Address - Phone:954-860-3216
Mailing Address - Fax:
Practice Address - Street 1:6285 ANGORA PEAK LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-1662
Practice Address - Country:US
Practice Address - Phone:954-860-3216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker