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
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
07/27/2026
Last updated
07/27/2026
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