Manchester Miracles Recovery Center, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MANCHESTER MIRACLES RECOVERY CENTER, LLC

Doing business as

Bluegrass Treatment Center

Practice address

1249 S Main St Ste 3
London, KY 40741-2004

Phone

(606) 595-3218

Fax

(606) 215-8372

NPI assigned

Mar 1, 2025

Last updated

May 10, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dustin B Phillips, M.S., LCADC, CAIMHPNPI 1922747831

Title

Clinical Director

Phone

(606) 595-3218

Specialties & licenses 5

Addresses

Other names 1

• Bluegrass Treatment Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dustin B Phillips, M.S., LCADC, CAIMHP

  • Addiction (Substance Use Disorder) Counselor
  • Corbin, KY
  • NPI 1922747831
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778371200000",
    "number": "1801693411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 SCARLET DR",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407018070",
            "telephone_number": "606-595-3218",
            "fax_number": "606-215-8372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1249 S MAIN ST STE 3",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407412004",
            "telephone_number": "606-595-3218",
            "fax_number": "606-215-8372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCHESTER MIRACLES RECOVERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-01",
        "last_updated": "2026-05-10",
        "certification_date": "2026-05-10",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "606-595-3218",
        "authorized_official_credential": "M.S., LCADC, CAIMHP"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluegrass Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassidy Mahan, LPCC
• Hassan Mahmood, M.D.
• Kamran Mahmood, MD
• Danielle Nicole Mallory, APRN
• Gilbert M Mamauag, M.D.
• Aqeel H Mandviwala, MD
• Khalid Jalil Manzar, M.D.
• Carley Marcum
• Cydney Marcum
• Virginia Ann Marcum, APRN

• Multi-Specialty Clinic/Center in London, KY
• Providers in London, KY by specialty
• Multi-Specialty Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.