1144928854 NPI number — AFFINITY HEALTHCARE, INC.

Table of content: (NPI 1144928854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144928854 NPI number — AFFINITY HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFINITY HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144928854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2380 N 400 E STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LOGAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84341-1756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-276-0888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
93 EAST 200 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 210-B
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-276-0888
Provider Business Practice Location Address Fax Number:
833-471-4536
Provider Enumeration Date:
02/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
LAVAL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
435-276-0888

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3006721 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4201995 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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