Provider Demographics
NPI:1811787781
Name:ENSEMBLE OF ALBUQUERQUE, LLC
Entity type:Organization
Organization Name:ENSEMBLE OF ALBUQUERQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:REYNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-726-4152
Mailing Address - Street 1:8725 ALAMEDA PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2475
Mailing Address - Country:US
Mailing Address - Phone:505-384-8374
Mailing Address - Fax:
Practice Address - Street 1:8725 ALAMEDA PARK DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2475
Practice Address - Country:US
Practice Address - Phone:505-384-8374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management