Organization
CASA BLOOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STA'NESHA RIVERO MSW,LCSW (EXECUTIVE DIRECTOR/THERAPIST)
(404) 630-0592
Entity
Organization
Contact information
Practice address
2706 MAIN AVE NW, HICKORY, NC 28601-5635
(404) 630-0592
Mailing address
5219 KODIAK CT, CHARLOTTE, NC 28215-8735
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/02/2026
Last updated
02/02/2026
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