| CASE NUMBER | I-200-24338-514861 |
| CASE STATUS | Certified |
| RECEIVED DATE | 12/3/2024 |
| DECISION DATE | 12/10/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Pediatric Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | Y |
| BEGIN DATE | 1/6/2025 |
| END DATE | 1/5/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | KEYSTONE RURAL HEALTH CENTER |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 111 Chambers Hill Drive |
| EMPLOYER ADDRESS2 | STE 200 |
| EMPLOYER CITY | CHAMBERSBURG |
| EMPLOYER STATE | PA |
| EMPLOYER POSTAL CODE | 17201 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | PENNSYLVANIA |
| EMPLOYER PHONE | 17177097900 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62111 |
| EMPLOYER POC LAST NAME | Cochran |
| EMPLOYER POC FIRST NAME | Joanne |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | President and CEO |
| EMPLOYER POC ADDRESS1 | 111 Chambers Hill Drive |
| EMPLOYER POC ADDRESS2 | STE 200 |
| EMPLOYER POC CITY | CHAMBERSBURG |
| EMPLOYER POC STATE | PA |
| EMPLOYER POC POSTAL CODE | 17201 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 17177097906 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | aehrhart@keystonehealth.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 | 111 Chambers Hill Drive |
| WORKSITE ADDRESS2 | Suite 202 |
| WORKSITE CITY | Chambersburg |
| WORKSITE COUNTY | FRANKLIN |
| WORKSITE STATE | PA |
| WORKSITE POSTAL CODE | 17201 |
| WAGE RATE OF PAY FROM | $250,000.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $325,000.00 |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $115,024.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 3 |
| 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 | 2025-01-06 |
