# ACTIVE LIFE SKILLS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326951302
- **Authorized official:** MR. GREGORY BLACK (OWNER)
- **Authorized official phone:** (262) 461-7585

## Contact information

- **Practice address:** 10225 W CAPITOL DR, WAUWATOSA, WI 53222-1305
- **Practice address phone:** (262) 461-7585
- **Mailing address:** 10225 W CAPITOL DR, WAUWATOSA, WI 53222-1305
- **Mailing address phone:** (262) 461-7585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 372600000X | Adult Companion | — | NULL | Yes |
| 372600000X | Adult Companion | — | — | Yes |

## Other

- **Enumeration date:** 09/23/2026
- **Last updated:** 09/23/2026