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Organization
ACTIVE LIFE SKILLS
Active
Organization
ACTIVE LIFE SKILLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY BLACK (OWNER)
(262) 461-7585
Entity
Organization
Contact information
Practice address
10225 W CAPITOL DR, WAUWATOSA, WI 53222-1305
(262) 461-7585
Mailing address
10225 W CAPITOL DR, WAUWATOSA, WI 53222-1305
(262) 461-7585
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
NULL
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
09/23/2026
Last updated
09/23/2026
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