902 E Main St Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

902 E MAIN ST OPCO LLC

Practice address

902 E Main St
San Augustine, TX 75972-2316

Phone

(936) 275-2055

Fax

(936) 275-5658

NPI assigned

Jun 27, 2025

Organization subpart

No

Name

Nochum Freund

Title

Manager

Phone

(732) 719-5098

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deepti A Govathoti, MD

  • Family Medicine Physician
  • Carthage, TX
  • NPI 1316190754
  NPD (past)
• Ahammed Hashim, M.D.

  • Pulmonary Disease Physician
  • Nacogdoches, TX
  • NPI 1235134420
  NPD (past)

• Avir at San Augustine Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 27, 2025.

{
    "created_epoch": "1750982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750982400000",
    "number": "1417845207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 E MAIN ST",
            "city": "SAN AUGUSTINE",
            "state": "TX",
            "postal_code": "759722316",
            "telephone_number": "936-275-2055",
            "fax_number": "936-275-5658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 E MAIN ST",
            "city": "SAN AUGUSTINE",
            "state": "TX",
            "postal_code": "759722316",
            "telephone_number": "936-275-2055",
            "fax_number": "936-275-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "902 E MAIN ST OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-27",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A",
        "authorized_official_last_name": "FREUND",
        "authorized_official_first_name": "NOCHUM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "732-719-5098"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avir at San Augustine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 902 E Main St TX15 Opco LLC
• Aqua Dialysis San Augustine, LLC
• Latasha Barnes
• Blake Barr
• Matthew Julian Bearden, LVN

• All providers in San Augustine, TX
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.