Organization
JOHNNY B'S, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIVIAN WIDEMAN (OWNER)
(704) 779-3275
Entity
Organization
Contact information
Practice address
2020 REMOUNT RD, GASTONIA, NC 28054-7476
(704) 779-3275
Mailing address
2020 REMOUNT RD, GASTONIA, NC 28054-7476
(704) 779-3275
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/29/2022
Last updated
09/02/2022
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