Healthcare Provider Details

I. General information

NPI: 1902583792
Provider Name (Legal Business Name): BRAINWAVES NEURO RESTORATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD
WARWICK RI
02886-1617
US

IV. Provider business mailing address

192 CINDYANN DR
EAST GREENWICH RI
02818-2428
US

V. Phone/Fax

Practice location:
  • Phone: 401-854-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA SLEPKOW
Title or Position: MANAGER
Credential:
Phone: 401-854-7550