Provider Demographics
NPI:1043407471
Name:HONDA SSA
Entity Type:Organization
Organization Name:HONDA SSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ETCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-832-4531
Mailing Address - Street 1:1100 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-5768
Mailing Address - Country:US
Mailing Address - Phone:806-832-4531
Mailing Address - Fax:806-832-1898
Practice Address - Street 1:1100 AVENUE K
Practice Address - Street 2:
Practice Address - City:SHALLOWATER
Practice Address - State:TX
Practice Address - Zip Code:79363-5768
Practice Address - Country:US
Practice Address - Phone:806-832-4531
Practice Address - Fax:806-832-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)