| LCA CASE NUMBER | I-200-22089-021768 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2022-03-30 |
| DECISION DATE | 2022-04-06 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | DENTIST |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2022-08-01 |
| END DATE | 2025-07-31 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | GOSHEN MEDICAL CENTER |
| EMPLOYER ADDRESS1 | 412 SW CENTER STREET |
| EMPLOYER CITY | FAISON |
| EMPLOYER STATE | NC |
| EMPLOYER POSTAL CODE | 28341 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 19102671942 |
| NAICS CODE | 621111 |
| EMPLOYER POC LAST NAME | BOUNDS |
| EMPLOYER POC FIRST NAME | GREG |
| EMPLOYER POC JOB TITLE | Chief Executive Officer |
| EMPLOYER POC ADDRESS1 | 412 SW CENTER STREET |
| EMPLOYER POC CITY | FAISON |
| EMPLOYER POC STATE | NC |
| EMPLOYER POC POSTAL CODE | 28341 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 19102671942 |
| EMPLOYER POC EMAIL | GBOUNDS@GOSHENMED.COM |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Tedrow |
| AGENT ATTORNEY FIRST NAME | Klari |
| AGENT ATTORNEY MIDDLE NAME | B |
| AGENT ATTORNEY ADDRESS1 | 2907 Central Avenue |
| AGENT ATTORNEY ADDRESS2 | Suite 109 |
| AGENT ATTORNEY CITY | Homewood |
| AGENT ATTORNEY STATE | AL |
| AGENT ATTORNEY POSTAL CODE | 35209 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 12058718084 |
| AGENT ATTORNEY EMAIL ADDRESS | Daizy@usimmigrant.net |
| LAWFIRM NAME BUSINESS NAME | Klari B. Tedrow, LLC |
| STATE OF HIGHEST COURT | AL |
| NAME OF HIGHEST STATE COURT | SUPREME COURT OF ALABAMA |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 460 SW Center Street |
| LCA CASE WORKLOC1 CITY | Faison |
| WORKSITE COUNTY | DUPLIN |
| LCA CASE WORKLOC1 STATE | NC |
| WORKSITE POSTAL CODE | 28341 |
| LCA CASE WAGE RATE FROM | 149999.98 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 88504 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2021 - 6/30/2022 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Tedrow |
| PREPARER FIRST NAME | Klari |
| PREPARER MIDDLE INITIAL | B. |
| PREPARER BUSINESS NAME | Klari B. Tedrow, LLC |
| PREPARER EMAIL | ktedrow@usimmigrant.net |
