Provider Demographics
NPI:1801693411
Name:MANCHESTER MIRACLES RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:MANCHESTER MIRACLES RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCADC, CAIMHP
Authorized Official - Phone:606-595-3218
Mailing Address - Street 1:214 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-1204
Mailing Address - Country:US
Mailing Address - Phone:606-595-3218
Mailing Address - Fax:606-215-8372
Practice Address - Street 1:214 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-1204
Practice Address - Country:US
Practice Address - Phone:606-595-3218
Practice Address - Fax:606-215-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty