902 E Main St TX15 Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

902 E MAIN ST TX15 OPCO LLC

Doing business as

San Augustine Nursing and Rehab Center

Practice address

902 E Main St
San Augustine, TX 75972-2316

Phone

(936) 275-2055

NPI assigned

Aug 13, 2026

Last updated

Aug 13, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jared Elliott

Title

Ceo

Phone

(718) 916-1443

Specialties & licenses 1

Addresses

Other names 1

• San Augustine Nursing and Rehab Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1786579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1962327197",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "902 E MAIN ST TX15 OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-13",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-916-1443"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Augustine Nursing and Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 902 E Main St Opco LLC (Avir at San Augustine)
• Aqua Dialysis San Augustine, LLC
• Latasha Barnes
• Blake Barr
• Matthew Julian Bearden, LVN
• Bio-Medical Applications of Texas, Inc. (Fresenius Kidney Care San Augustine Dialysis Center)

• Skilled Nursing Facility in San Augustine, TX
• Providers in San Augustine, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; 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.