Healthcare Provider Details

I. General information

NPI: 1144928854
Provider Name (Legal Business Name): AFFINITY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 EAST 200 SOUTH SUITE 210-B
LOGAN UT
84321
US

IV. Provider business mailing address

2380 N 400 E STE B
NORTH LOGAN UT
84341-1756
US

V. Phone/Fax

Practice location:
  • Phone: 435-276-0888
  • Fax: 833-471-4536
Mailing address:
  • Phone: 435-276-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAVAL B JENSEN
Title or Position: CEO
Credential:
Phone: 435-276-0888