NPIMap

Organization Active NPI

Mt Enterprise Community Health Clinic

Doing business as Crossroads Family Care

  • Federally Qualified Health Center (FQHC)
  • Henderson, TX
National Provider Identifier
1649412354
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MT ENTERPRISE COMMUNITY HEALTH CLINIC
Doing business as
Crossroads Family Care
Practice address
1115 Highway 259 South
Henderson, TX 75654
Phone
(903) 822-3076
Fax
(903) 822-3079
NPI assigned
Mar 26, 2009
Last updated
Apr 27, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MT ENTERPRISE COMMUNITY HEALTH CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

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

Authorized official

Name
Becky Eldridge
Title
Ceo
Phone
(903) 392-8203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1115 Highway 259 South
Henderson, TX 75654

Mailing address

PO Box 489
Mount Enterprise, TX 75681-0489
Phone (903) 822-3076

Other identifiers 2

IdentifierTypeStateIssuer
203375501MedicaidTX
203375502MedicaidTX

Other names 1

  • Crossroads Family Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090916000106 TX Part A Provider - Federally Qualified Health Center (FQHC) 2860303922 Practice locations: Henderson, TX
O20110801000150 TX Part B Supplier - Clinic/Group Practice 2860303922 Receives reassigned benefits from 12 practitioners
3 other NPIs on this enrollment
Practice locations: Henderson, TX; Mt. Enterprise, TX; Palestine, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649412354. Details of each certification follow.

Federally qualified health center certification: CCN 671921

Legal name
MT ENTERPRISE COMMUNITY HEALTH CLINIC
Doing business as
CROSSROADS FAMILY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 23, 2009
Last certification
Sep 23, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 21, 2003 in TX
Enrollment address
1115 US Highway 259 S
Henderson, TX 75654-3629

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Mt Enterprise Community Hea

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Matt Gholson Individual Corporate Director Feb 12, 2012
Becky Eldridge Individual Corporate Director Oct 24, 2012
Leo Gonzalez Individual Corporate Director Mar 29, 2012
Harvey L Graves Individual Corporate Director Jul 1, 2009
Yolanda Deleon Individual Corporate Director Feb 21, 2020
Kenneth a. White Individual Corporate OfficerCeo Oct 14, 2013 100%
Michelle Simmons Individual Corporate Director Oct 21, 2016
Roslyn Grigsby Individual Operational/Managerial ControlBilling / Credentialing Manager Oct 14, 2013

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1238025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1649412354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 489",
            "city": "MOUNT ENTERPRISE",
            "state": "TX",
            "postal_code": "756810489",
            "telephone_number": "903-822-3076",
            "fax_number": "903-822-3079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 HIGHWAY 259 SOUTH",
            "city": "HENDERSON",
            "state": "TX",
            "postal_code": "75654",
            "telephone_number": "903-822-3076",
            "fax_number": "903-822-3079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT ENTERPRISE COMMUNITY HEALTH CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MT ENTERPRISE COMMUNITY HEALTH CLINIC",
        "enumeration_date": "2009-03-26",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "ELDRIDGE",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-392-8203"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203375501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203375502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, TX

Sources for this page

Verify at the official NPI Registry.