MEDICARE: HERITAGE CHARTER ACADEMY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1740061472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE CHARTER ACADEMY INC

Provider Business Mailing Address
First Line	:	2107 SANTA BARBARA BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-4335
Country	:	US
Telephone Number	:	239-829-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 SANTA BARBARA BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-4335
Country	:	US
Telephone Number	:	239-829-5134
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	MS. SHELLY HOMAN
Credential	:	ED.S
Telephone Number	:	239-829-5134

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	04/01/2025

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