Healthcare Provider Details

I. General information

NPI: 1114867249
Provider Name (Legal Business Name): NOVA SORELLA SORORITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 CALIFORNIA AVE
BAKERSFIELD CA
93304-1074
US

IV. Provider business mailing address

7456 HALPIN DR
SAINT LOUIS MO
63135-3426
US

V. Phone/Fax

Practice location:
  • Phone: 314-936-1806
  • Fax:
Mailing address:
  • Phone: 314-936-1806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAULINE JONES
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 314-936-1806