| CASE NUMBER | I-200-23329-522740 |
| CASE STATUS | Certified |
| RECEIVED DATE | 11/25/2023 |
| DECISION DATE | 12/1/2023 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Occupational Therapist-DOR |
| SOC CODE | 29-1122.00 |
| SOC TITLE | Occupational Therapists |
| FULL TIME POSITION | Y |
| BEGIN DATE | 5/1/2024 |
| END DATE | 4/30/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | INTERFACE REHAB INC. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 774 S Placentia Avenue |
| EMPLOYER ADDRESS2 | Suite # 200 |
| EMPLOYER CITY | Placentia |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 92870 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 17146468904 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62134 |
| EMPLOYER POC LAST NAME | VU |
| EMPLOYER POC FIRST NAME | JANSEN |
| EMPLOYER POC MIDDLE NAME | N/A |
| EMPLOYER POC JOB TITLE | Controller |
| EMPLOYER POC ADDRESS1 | 774 S PLACENTIA AVENUE |
| EMPLOYER POC ADDRESS2 | Suite # 200 |
| EMPLOYER POC CITY | Placentia |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 92870 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 17146468904 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | JANSEN@INTERFACEREHAB.COM |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Shah |
| AGENT ATTORNEY FIRST NAME | Bharati |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | P O Box 418 |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Placentia |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 92871 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 17145252000 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | bharatilaw@gmail.com |
| LAWFIRM NAME BUSINESS NAME | Law Offices of Bharati Shah |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | CA |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | Yes |
| SECONDARY ENTITY BUSINESS NAME | Country Villa Nursing & Rehab Center |
| WORKSITE ADDRESS1 | 340 S Alvarado Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Los Angeles |
| WORKSITE COUNTY | LOS ANGELES |
| WORKSITE STATE | CA |
| WORKSITE POSTAL CODE | 90057 |
| WAGE RATE OF PAY FROM | 45 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $41.30 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Shah |
| PREPARER FIRST NAME | Bharati |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Law Offices of Bharati Shah |
| PREPARER EMAIL | bharatilaw@gmail.com |
| BEGIN DATE CONVERTED | 2024-01-05 |
