Christiana Care Havertown ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

CHRISTIANA CARE HAVERTOWN ASC, LLC

Practice address

2010 W Chester Pike Ste 212
Havertown, PA 19083-2736

Phone

(610) 853-7700

NPI assigned

Jun 16, 2025

Last updated

Jun 19, 2025By 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

Douglas Azar

Title

Director/Officer

Phone

(484) 678-8475

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063308096. Details of each certification follow.

• CCN 39C0001401 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 39C0001401

Legal name

CHRISTIANA CARE HAVERTOWN ASC LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Nov 24, 2025

Last certification

Sep 17, 2025

Ownership / control type

Proprietary

Facility address

2010 West Chester Pike Suite 212
Havertown, PA 19083

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Christiana Care Pennsylvania Inc

  dba CCHS Pulmonary Practice PA

  • Pulmonary Disease Physician
  • Glen Mills, PA
  • NPI 1982592119

  Member Of

  NPD member

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

{
    "created_epoch": "1750032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750291200000",
    "number": "1063308096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 W CHESTER PIKE STE 212",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190832736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 W CHESTER PIKE STE 212",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190832736",
            "telephone_number": "610-853-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIANA CARE HAVERTOWN ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-16",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A",
        "authorized_official_last_name": "AZAR",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "DIRECTOR/OFFICER",
        "authorized_official_telephone_number": "484-678-8475"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Child Guidance Resource Centers Inc
• Chin-Suk John Cho, D.C, DACBR, RMSK
• Yoon-Jung Dianna Cho, O.D.
• Ul Sik Jason Chong, DOCTORATE OF PHARMAC
• Larry H Chou, M.D.
• Kathleen Civitello
• Patricia Ann Clancy, M.D.
• Stacina Elizabeth Clark, LPC
• Kathleen Clarke, LPC, MBA, CAADC
• Kelly Anne Clarke, MSW

• Ambulatory Surgical Clinic/Center in Havertown, PA
• Providers in Havertown, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.