Active Life Skills

Primary specialty

Adult CompanionTaxonomy code 372600000X

Legal business name

ACTIVE LIFE SKILLS

Practice address

10225 W Capitol Dr
Wauwatosa, WI 53222-1305

Phone

(262) 461-7585

NPI assigned

Sep 23, 2026

Last updated

Sep 23, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gregory Black

Title

Owner

Phone

(262) 461-7585

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1326951302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10225 W CAPITOL DR",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532221305",
            "telephone_number": "262-461-7585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10225 W CAPITOL DR",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532221305",
            "telephone_number": "262-461-7585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE SKILLS",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-23",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-461-7585",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.