Provider Demographics
NPI:1811193063
Name:SOURCEWISE
Entity Type:Organization
Organization Name:SOURCEWISE
Other - Org Name:COUNCIL ON AGING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL PINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-350-3231
Mailing Address - Street 1:3100 DE LA CRUZ BLVD
Mailing Address - Street 2:#310
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054
Mailing Address - Country:US
Mailing Address - Phone:408-350-3200
Mailing Address - Fax:855-965-0948
Practice Address - Street 1:3100 DE LA CRUZ BLVD
Practice Address - Street 2:#310
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054
Practice Address - Country:US
Practice Address - Phone:408-350-3200
Practice Address - Fax:855-965-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMSS00020FMedicaid