MEDICARE: SOURCEWISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1598196651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOURCEWISE

Provider Business Mailing Address
First Line	:	3100 DE LA CRUZ BLVD STE 310
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-2452
Country	:	US
Telephone Number	:	408-350-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 DE LA CRUZ BLVD STE 310
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-2452
Country	:	US
Telephone Number	:	408-350-3278
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CARE MANAGEMENT
Name	:	LISA ROBIN WHITMORE
Credential	:	LCSW
Telephone Number	:	408-350-3278

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	03/03/2022

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Directions to “SOURCEWISE ” Practice Location

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