Provider Demographics
NPI:1407076276
Name:ANNA GOLD CO., INC.
Entity Type:Organization
Organization Name:ANNA GOLD CO., INC.
Other - Org Name:MILLENNIUM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKIFOROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-583-0859
Mailing Address - Street 1:2150 WINIFRED ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2934
Mailing Address - Country:US
Mailing Address - Phone:805-583-0859
Mailing Address - Fax:805-583-8957
Practice Address - Street 1:2150 WINIFRED ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2934
Practice Address - Country:US
Practice Address - Phone:805-583-0859
Practice Address - Fax:805-583-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70336FMedicaid