| LCA CASE NUMBER | I-200-21096-201022 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-04-06 |
| DECISION DATE | 2021-04-13 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Licensed Nursing Home Administrator |
| SOC CODE | 11-9111.00 |
| SOC TITLE | Medical and Health Services Managers |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-05-03 |
| END DATE | 2024-05-02 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | 2850 Grand Island Boulevard Operating Company, LLC |
| TRADE NAME DBA | Elderwood at Grand Island |
| EMPLOYER ADDRESS1 | 2850 Grand Island Blvd. |
| EMPLOYER CITY | Grand Island |
| EMPLOYER STATE | NY |
| EMPLOYER POSTAL CODE | 14072 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 17167735900 |
| NAICS CODE | 62311 |
| EMPLOYER POC LAST NAME | Shrock |
| EMPLOYER POC FIRST NAME | Jamie |
| EMPLOYER POC JOB TITLE | Director of Talent Management |
| EMPLOYER POC ADDRESS 1 | 2850 Grand Island Blvd. |
| EMPLOYER POC CITY | Grand Island |
| EMPLOYER POC STATE | NY |
| EMPLOYER POC POSTAL CODE | 14072 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 17167735900 |
| EMPLOYER POC EMAIL | [email protected] |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Sobieski |
| AGENT ATTORNEY FIRST NAME | Lee |
| AGENT ATTORNEY MIDDLE NAME | Michael |
| AGENT ATTORNEY ADDRESS1 | 5530 Sheridan drive |
| AGENT ATTORNEY ADDRESS2 | suite 1 |
| AGENT ATTORNEY CITY | Buffalo |
| AGENT ATTORNEY STATE | NY |
| AGENT ATTORNEY POSTAL CODE | 14221 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | New York |
| AGENT ATTORNEY PHONE | 17166346500 |
| AGENT ATTORNEY EMAIL ADDRESS | [email protected] |
| LAWFIRM NAME BUSINESS NAME | Berger Berger & Sobieski |
| STATE OF HIGHEST COURT | NY |
| NAME OF HIGHEST STATE COURT | Appellate Division, Fourth Department |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 2850 Grand Island Blvd. |
| LCA CASE WORKLOC1 CITY | Grand Island |
| WORKSITE COUNTY | ERIE |
| LCA CASE WORKLOC1 STATE | NY |
| WORKSITE POSTAL CODE | 14072 |
| LCA CASE WAGE RATE FROM | 120000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 103626 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Sobieski |
| PREPARER FIRST NAME | Lee |
| PREPARER MIDDLE INITIAL | M |
| PREPARER BUSINESS NAME | Berger Berger and Sobieski |
| PREPARER EMAIL | [email protected] |
