| CASE NUMBER | I-200-24180-159665 |
| CASE STATUS | Certified |
| RECEIVED DATE | 6/28/2024 |
| DECISION DATE | 7/8/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Staff Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | N |
| BEGIN DATE | 7/1/2024 |
| END DATE | 6/30/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 1 |
| EMPLOYER NAME | GOLDEN VALLEY HEALTH CENTERS |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 737 WEST CHILDS AVENUE |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | MERCED |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 95341 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | CALIFORNIA |
| EMPLOYER PHONE | +12093855205 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62111 |
| EMPLOYER POC LAST NAME | Colomer |
| EMPLOYER POC FIRST NAME | Ruth |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Manager of Provider Staff Services |
| EMPLOYER POC ADDRESS1 | 737 WEST CHILDS AVENUE |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | MERCED |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 95341 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | +12093846491 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | rcolomer@gvhc.org |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Kelly |
| AGENT ATTORNEY FIRST NAME | Dayna |
| AGENT ATTORNEY MIDDLE NAME | Jo |
| AGENT ATTORNEY ADDRESS1 | 101 Two Hills Drive |
| AGENT ATTORNEY ADDRESS2 | Suite 220 |
| AGENT ATTORNEY CITY | Carrboro |
| AGENT ATTORNEY STATE | NC |
| AGENT ATTORNEY POSTAL CODE | 27510 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | +19199697200 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | INFO@DKELLY.COM |
| LAWFIRM NAME BUSINESS NAME | Law Offices of Dayna Kelly, PC |
| STATE OF HIGHEST COURT | NC |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 200 C Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Patterson |
| WORKSITE COUNTY | STANISLAUS |
| WORKSITE STATE | CA |
| WORKSITE POSTAL CODE | 95363 |
| WAGE RATE OF PAY FROM | 77.16 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $84.87 |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $44.23 |
| 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 | 9 |
| 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 | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2024-01-07 |
