Healthcare Provider Details

I. General information

NPI: 1811787781
Provider Name (Legal Business Name): ENSEMBLE OF ALBUQUERQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 ALAMEDA PARK DR NE
ALBUQUERQUE NM
87113-2475
US

IV. Provider business mailing address

8725 ALAMEDA PARK DR NE
ALBUQUERQUE NM
87113-2475
US

V. Phone/Fax

Practice location:
  • Phone: 505-384-8374
  • Fax:
Mailing address:
  • Phone: 505-384-8374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: REYNOLD BUNZEL
Title or Position: CIO
Credential:
Phone: 505-726-4152