# ANTICO MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mel's House of healing
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164344768
- **Authorized official:** DR. JIDA HUBANA MD (PRESIDENT)
- **Authorized official phone:** (614) 254-9761

## Contact information

- **Practice address:** 75 NW COUCH ST STE 300, PORTLAND, OR 97209-4018
- **Practice address phone:** (614) 254-9761
- **Mailing address:** 75 NW COUCH ST STE 300, PORTLAND, OR 97209-4018
- **Mailing address phone:** (614) 254-9761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/27/2026
- **Last updated:** 07/27/2026