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Organization
ANTICO MEDICAL LLC
Active
Organization
ANTICO MEDICAL LLC
Active
Other names
Mel's House of healing
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIDA HUBANA MD (PRESIDENT)
(614) 254-9761
Entity
Organization
Contact information
Practice address
75 NW COUCH ST STE 300, PORTLAND, OR 97209-4018
(614) 254-9761
Mailing address
75 NW COUCH ST STE 300, PORTLAND, OR 97209-4018
(614) 254-9761
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
Other
Enumeration date
07/27/2026
Last updated
07/27/2026
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