| CASE NUMBER | I-200-24127-962737 |
| CASE STATUS | Certified |
| RECEIVED DATE | 5/6/2024 |
| DECISION DATE | 5/13/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Physical Therapist |
| SOC CODE | 29-1123.00 |
| SOC TITLE | Physical Therapists |
| FULL TIME POSITION | Y |
| BEGIN DATE | 5/13/2024 |
| END DATE | 5/12/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Ensign Montgomery, LLC |
| TRADE NAME DBA | Park View Post Acute |
| EMPLOYER ADDRESS1 | 3751 Montgomery Drive |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Santa Rosa |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 95405 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 19494879500 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62311 |
| EMPLOYER POC LAST NAME | Burnam |
| EMPLOYER POC FIRST NAME | Soon |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Treasurer |
| EMPLOYER POC ADDRESS1 | 29222 Rancho Viejo Road |
| EMPLOYER POC ADDRESS2 | Suite 127 |
| EMPLOYER POC CITY | San Juan Capistrano |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 92675 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19494879500 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | uguzman@ensignservices.net |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Kaltenbach |
| AGENT ATTORNEY FIRST NAME | Adam |
| AGENT ATTORNEY MIDDLE NAME | K |
| AGENT ATTORNEY ADDRESS1 | 14781 Pomerado Road |
| AGENT ATTORNEY ADDRESS2 | Ste. 21 |
| AGENT ATTORNEY CITY | Poway |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 92064 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 19189918670 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | akk@akaltenbachlaw.onmicrosoft.com |
| LAWFIRM NAME BUSINESS NAME | A. Kaltenbach Law, A.P.C. |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | State Bar of California |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 3751 Montgomery Drive |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Santa Rosa |
| WORKSITE COUNTY | SONOMA |
| WORKSITE STATE | CA |
| WORKSITE POSTAL CODE | 95405 |
| WAGE RATE OF PAY FROM | 70 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $67.74 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | IV |
| 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 | Kaltenbach |
| PREPARER FIRST NAME | Adam |
| PREPARER MIDDLE INITIAL | K |
| PREPARER BUSINESS NAME | A. Kaltenbach Law, A.P.C. |
| PREPARER EMAIL | akk@akaltenbachlaw.onmicorsoft.com |
| BEGIN DATE CONVERTED | 2025-01-05 |
